Capernaum Medical Center for Kids PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

CAPERNAUM MEDICAL CENTER FOR KIDS PLLC

Practice address

2024 Edgewood Dr S
Lakeland, FL 33803-3637

Phone

(863) 232-4323

Fax

(863) 337-5728

NPI assigned

Oct 10, 2018

Organization subpart

Yes

Parent organization

CAPERNAUM MEDICAL CENTER FOR KIDS, PLLCAs reported in NPPES

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

Authorized official

Name

Eric Roberto Vernier, MD

Title

MD

Phone

(813) 647-6050

Specialties & licenses 1

Addresses

Tax ID family

Capernaum Medical Center for Kids PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Capernaum Medical Center for Kids PLLC

  • Medical Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1518432038
  NPD tax ID
• Capernaum Medical Center for Kids PLLC

  • Clinical Neurophysiology Physician
  • Lakeland, FL
  • NPI 1881146413
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Irene P Malone, APRN

  • Family Nurse Practitioner
  • Lakeland, FL
  • NPI 1578395984
  NPD (past)
• Reanna Maxwell, ARNP

  • Family Nurse Practitioner
  • Lakeland, FL
  • NPI 1013554138
  NPD (past)

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723680000000",
    "number": "1417422015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 EDGEWOOD DR S",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338033637",
            "telephone_number": "863-232-4323",
            "fax_number": "863-337-5728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 EDGEWOOD DR S",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338033637",
            "telephone_number": "863-232-4323",
            "fax_number": "863-337-5728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5129 S Lakeland Dr Ste 2",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338132599",
            "country_code": "US",
            "telephone_number": "863-232-4323",
            "fax_number": "863-337-5728",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3040 Park Pond Way",
            "address_purpose": "LOCATION",
            "city": "Kissimmee",
            "state": "FL",
            "postal_code": "347417662",
            "country_code": "US",
            "telephone_number": "863-232-4323",
            "fax_number": "863-337-5728",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Westshore Plz",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336091811",
            "country_code": "US",
            "telephone_number": "863-232-4323",
            "fax_number": "863-337-5728",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4710 N Habana Ave Ste 404",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336147152",
            "country_code": "US",
            "telephone_number": "863-232-4323",
            "fax_number": "863-337-5728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CAPERNAUM MEDICAL CENTER FOR KIDS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAPERNAUM MEDICAL CENTER FOR KIDS, PLLC",
        "enumeration_date": "2018-10-10",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A",
        "authorized_official_last_name": "VERNIER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "ROBERTO",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "813-647-6050",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hilda Valbrun Canon, APRN
• John Gerald Galvez Canto, MD
• Theresa Cao, D.O.
• Capernaum Autism Center LLC
• Capernaum Medical Center
• Capernaum Medical Center for Kids PLLC
• Capernaum Medical Center for Kids PLLC
• Alison Caracciola, BCBA
• Gabriel De Jesus Carballo Gutierrez
• Arabel B Cardano

• Clinic/Center in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.