NPIMap

Organization Active NPI

Renaissance Pediatrics PC

  • Pediatrics Physician
  • Chesapeake, VA
National Provider Identifier
1427061340
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
RENAISSANCE PEDIATRICS PC
Practice address
4012 Raintree Rd
Suite 200a
Chesapeake, VA 23321-3741
Phone
(757) 488-2223
Fax
(757) 488-8398
NPI assigned
Aug 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Sandra S Baucom, MDNPI 1184673584
Title
President
Phone
(757) 488-2223

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

4012 Raintree Rd
Suite 200a
Chesapeake, VA 23321-3741

Mailing address

4012 Raintree Rd
Suite 200a
Chesapeake, VA 23321-3741
Phone (757) 488-2223

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
49D0896535Renaissance Pediatrics, PC4012 Raintree Road Suite 200a, Chesapeake, VA 23321Certificate of waiverJun 1, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427061340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 RAINTREE RD",
            "address_2": "SUITE 200A",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213741",
            "telephone_number": "757-488-2223",
            "fax_number": "757-488-8398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4012 RAINTREE RD",
            "address_2": "SUITE 200A",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213741",
            "telephone_number": "757-488-2223",
            "fax_number": "757-488-8398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAUCOM",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-488-2223",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.