NPIMap

Organization Active NPI

Little Pine Pediatrics, PLLC

  • Rural Health Clinic/Center
  • Perry, FL
National Provider Identifier
1376784702
Registry record updated Feb 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LITTLE PINE PEDIATRICS, PLLC
Practice address
1702 S Jefferson St
Perry, FL 32348-5611
Phone
(855) 577-5437
Fax
(850) 838-2140
NPI assigned
Mar 16, 2009
Last updated
Feb 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ronald Emerick, D.O.NPI 1205894425
Title
Owner
Phone
(855) 577-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X OS9746 FL
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1702 S Jefferson St
Perry, FL 32348-5611

Mailing address

1702 S Jefferson St
Perry, FL 32348-5611
Phone (855) 577-5437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110215000367 FL Part A Provider - Rural Health Clinic 0244380152 Practice locations: Perry, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376784702. Details of each certification follow.

Rural health clinic certification: CCN 103808

Legal name
LITTLE PINE PEDIATRICS, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 16, 2012
Last certification
Jul 18, 2024
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
1702 S Jefferson St
Perry, FL 32348-5611

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

15551 NW US Highway 441
Unit 40
Alachua, FL 32615
Phone (386) 518-0102

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kimberly Stroud Individual W-2 Managing EmployeePractice Manager Jul 20, 2016
Ronald Emerick Individual 5% Or Greater Direct Ownership Interest Jul 3, 2009 99%
Corporate DirectorMedical Director/Owner Jul 3, 2009 100%
W-2 Managing EmployeeMedical/Director/Owner Jul 3, 2009 50%
April Dice Individual W-2 Managing EmployeeArpn Jan 1, 2020
Laurie Shaw Individual W-2 Managing EmployeeOffice Manager Jul 20, 2016
Venette Pierre Individual W-2 Managing EmployeeDO/Medical Provider Jul 20, 2016 7%
Hayden Hagberg Individual W-2 Managing EmployeeNurse Manager Jul 20, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454889600000",
    "number": "1376784702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 S JEFFERSON ST",
            "city": "PERRY",
            "state": "FL",
            "postal_code": "323485611",
            "telephone_number": "855-577-5437",
            "fax_number": "850-838-2140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 S JEFFERSON ST",
            "city": "PERRY",
            "state": "FL",
            "postal_code": "323485611",
            "telephone_number": "855-577-5437",
            "fax_number": "850-838-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE PINE PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2016-02-08",
        "status": "A",
        "authorized_official_last_name": "EMERICK",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-577-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS9746",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perry, FL

Sources for this page

Verify at the official NPI Registry.