NPIMap

Organization Active NPI

Pediatric and Internal Medicine Specialists Inc

Doing business as PedIM Healthcare

  • Family Medicine Physician
  • Lecanto, FL
National Provider Identifier
1396805115
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS INC
Doing business as
PedIM Healthcare
Practice address
1990 N Prospect Ave
Lecanto, FL 34461-9792
Phone
(352) 527-6888
Fax
(352) 527-8818
NPI assigned
Dec 11, 2006
Last updated
Feb 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Authorized official

Name
Dr. Dacelin St. Martin, MDNPI 1457392136
Title
Medical Director/Owner
Phone
(352) 527-6888

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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 10D1050573 FL
Physical Therapy Clinic/Center 261QP2000X NU
Sleep Disorder Diagnostic Clinic/Center 261QS1200X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU
Medical Laboratory Technician 246RM2200X NU

Addresses

Primary practice location

1990 N Prospect Ave
Lecanto, FL 34461-9792

Mailing address

PO Box 2066
Lecanto, FL 34460-2066
Phone (352) 527-6888

Other practice location 1

8468 W Periwinkle Ln
Homosassa, FL 34446-1147
Phone (352) 628-7270

Other practice location 2

1980 N Prospect Ave
Lecanto, FL 34461-9792
Phone (352) 527-6673

Other names 1

  • PedIM Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109000787 FL Part B Supplier - Clinic/Group Practice 4486672391 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
Practice locations: Dunnellon, FL; Inverness, FL; Lecanto, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2121835Pediatric and Internal Medicine Specialists LLC8468 W Periwinkle LN, Homosassa, FL 34446Certificate of waiverNov 14, 2026

National Provider Directory

National Provider Directory

Locations

3580 E Gulf To Lake Hwy
Inverness, FL 34453
Phone (352) 527-6888

1978 N Prospect Ave
Lecanto, FL 34461

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1396805115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2066",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344602066",
            "telephone_number": "352-527-6888",
            "fax_number": "352-527-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 N PROSPECT AVE",
            "city": "LECANTO",
            "state": "FL",
            "postal_code": "344619792",
            "telephone_number": "352-527-6888",
            "fax_number": "352-527-8818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8468 W Periwinkle Ln",
            "address_purpose": "LOCATION",
            "city": "Homosassa",
            "state": "FL",
            "postal_code": "344461147",
            "country_code": "US",
            "telephone_number": "352-628-7270",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1980 N Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Lecanto",
            "state": "FL",
            "postal_code": "344619792",
            "country_code": "US",
            "telephone_number": "352-527-6673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "ST. MARTIN",
        "authorized_official_first_name": "DACELIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "352-527-6888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "10D1050573",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "246RM2200X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PedIM Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lecanto, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.