NPIMap

Organization Active NPI

North Florida Pediatrics, PA

  • Pediatrics Physician
  • Live Oak, FL
National Provider Identifier
1396415915
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTH FLORIDA PEDIATRICS, PA
Practice address
North Florida Pediatrics, PA
1101 Ohio Avenue South
Live Oak, FL 32064
Phone
(386) 339-1060
Fax
(386) 339-1067
NPI assigned
Sep 15, 2021
Last updated
Sep 15, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH FLORIDA PEDIATRICS, PA.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Authorized official

Name
Samuel Santelices, MD.NPI 1669476552
Title
President/ Ceo
Phone
(386) 758-0003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

North Florida Pediatrics, PA
1101 Ohio Avenue South
Live Oak, FL 32064

Mailing address

1859 SW Newland Way
Lake City, FL 32025
Phone (386) 758-0003

Other identifiers 1

IdentifierTypeStateIssuer
015048101MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
North Florida Pediatrics PA18 organizations share this tax ID, including this one
Part of
North Florida Pediatrics PA

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Practitioners & affiliated clinicians

Practitioners 1

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": "1631664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1396415915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1859 SW NEWLAND WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-758-0003",
            "fax_number": "386-755-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NORTH FLORIDA PEDIATRICS, PA",
            "address_2": "1101 OHIO AVENUE SOUTH",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "32064",
            "telephone_number": "386-339-1060",
            "fax_number": "386-339-1067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FLORIDA PEDIATRICS, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH FLORIDA PEDIATRICS, PA.",
        "enumeration_date": "2021-09-15",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "SANTELICES",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "386-758-0003",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "015048101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Live Oak, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.