Pediatric Assoc of Petersburg

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101026123 Issued in VA

Legal business name

PEDIATRIC ASSOC OF PETERSBURG

Practice address

13213 Rivers Bend Blvd
Chester, VA 23836-8606

Phone

(804) 530-7413

Fax

(804) 530-7411

NPI assigned

Apr 27, 2007

Organization subpart

No

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

Authorized official

Name

Patricia D Gonzales, MD

Title

Medical Director

Phone

(804) 530-7413

Specialties & licenses 1

Addresses

Other identifiers 20

Other names 1

• Infant Jesus Childrens Clinic Doing business as

Tax ID family

Infant Jesus Children'S Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Pediatric Associates of Petersburg PLC

  • Pediatrics Physician
  • Petersburg, VA
  • NPI 1891714911
  NPD tax ID

Locations

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457571754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13213 RIVERS BEND BLVD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238368606",
            "telephone_number": "804-530-7413",
            "fax_number": "804-530-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13213 RIVERS BEND BLVD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238368606",
            "telephone_number": "804-530-7413",
            "fax_number": "804-530-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOC OF PETERSBURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "804-530-7413",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101026123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM CHOICE DR TAMARA",
            "identifier": "2134065",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA HEALTH MEDICAID HM",
            "identifier": "13767",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM CHOICE DR HERMES",
            "identifier": "213114",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALLIANCE PPO DR TAMARA CH",
            "identifier": "2134065",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA DRPATRICIA GONZALES",
            "identifier": "4365024",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA DR TAMARA CHARITY B",
            "identifier": "6657468",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA DR HERMES DIZON",
            "identifier": "6674705",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA DRPATRICIA GONZALES",
            "identifier": "1243417",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH DR PATRIC",
            "identifier": "266582",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDIPA DR TAMARA CHARITY B",
            "identifier": "2134065",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA OPTIMA HEALTH DR",
            "identifier": "23468",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE DR PATR",
            "identifier": "1201542",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "466594",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA OPTIMA HEALTH DR",
            "identifier": "13767",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH DR HERMES",
            "identifier": "306087",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI DR PATRICIA GONZALE",
            "identifier": "2100405",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDIPA DR HERMES DIZON",
            "identifier": "213114",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARENET DR PATRICIA GONZA",
            "identifier": "5293",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE DR HERM",
            "identifier": "002478499004",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARENET DR TAMARA CHARITY",
            "identifier": "57968",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Infant Jesus Childrens Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pediatrics Physician in Chester, VA
• Providers in Chester, VA by specialty
• Pediatrics Physician in Virginia

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.