Park Avenue Pediatrics PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

38443 Issued in NC

Legal business name

PARK AVENUE PEDIATRICS PA

Practice address

529 Becker Dr
Roanoke Rapids, NC 27870-3303

Phone

(252) 537-6465

Fax

(252) 535-0951

NPI assigned

Apr 28, 2006

Organization subpart

No

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

Authorized official

Name

Sandeep Kumar Tiwari, MDNPI 1669450458

Title

President

Phone

(252) 537-6465

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 3

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

• Sandeep Kumar Tiwari, MD

  • Pediatrics Physician
  • Roanoke Rapids, NC
  • NPI 1669450458
  Medicare reassignment Authorized official
• Morgan Keeter, NP-C

  • Family Nurse Practitioner
  • Roanoke Rapids, NC
  • NPI 1528691300
  NPD
• Laila Gowani Valliani

  • Family Nurse Practitioner
  • Roanoke Rapids, NC
  • NPI 1346996915
  NPD

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1417914797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 BECKER DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278703303",
            "telephone_number": "252-537-6465",
            "fax_number": "252-535-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 BECKER DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278703303",
            "telephone_number": "252-537-6465",
            "fax_number": "252-535-0951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "TIWARI",
        "authorized_official_first_name": "SANDEEP",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-537-6465",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "38443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC NC",
            "identifier": "15527",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC VA",
            "identifier": "139315",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8915527",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006701019",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chinedu Christian Onuorah, M.D,
• Lisa K Page, LPC
• Virgil Thomas Pair, FNP
• Nexer Jasser Palacios, MD
• Roxana R Paolella, LCSWA
• Mahendra S Patel, MD
• Jennifer Jean Payne, LPC, CCMC
• Marcus A Pearson Jr.
• Michelle Mary Jane Peay, PMHNP
• Clyde Douglas Peedin Jr., DDS

• Pediatrics Physician in Roanoke Rapids, NC
• Providers in Roanoke Rapids, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; 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.