NPIMap

Organization Active NPI

Pediatric and Internal Medicine Specialists, PA

  • Rural Health Clinic/Center
  • Lecanto, FL
National Provider Identifier
1437575693
Registry record updated Mar 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
1396805115 Issued in FL
Legal business name
PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS, PA
Practice address
1990 N Prospect Ave
Lecanto, FL 34461-9792
Phone
(352) 527-6888
Fax
(352) 527-8818
NPI assigned
Mar 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2014

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

Authorized official

Name
Ms. Karen Marcia Fenton
Title
Office Manager
Phone
(352) 527-6888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 1396805115 FL Primary

Addresses

Primary practice location

1990 N Prospect Ave
Lecanto, FL 34461-9792

Mailing address

1990 N Prospect Ave
Lecanto, FL 34461-9792
Phone (352) 527-6888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Rural health clinic certification: CCN 103863

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS PA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 12, 2010
Last certification
Aug 3, 2023
Ownership / control type
1B
Facility address
1990 N Prospect Ave
Lecanto, FL 34461

National Provider Directory

National Provider Directory
Tax ID family
Pediatric and Internal Medicine Specialists Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394582400000",
    "number": "1437575693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": [],
    "basic": {
        "organization_name": "PEDIATRIC AND INTERNAL MEDICINE SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-12",
        "last_updated": "2014-03-12",
        "status": "A",
        "authorized_official_last_name": "FENTON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MARCIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "352-527-6888",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "1396805115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lecanto, FL

Sources for this page

Verify at the official NPI Registry.