Pediatric Innovation Center, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME86016 Issued in FL

Legal business name

PEDIATRIC INNOVATION CENTER, LLC

Practice address

13241 Bartram Park Blvd
Suite 209
Jacksonville, FL 32258-5212

Phone

(904) 616-2772

Fax

(904) 674-2313

NPI assigned

Aug 4, 2016

Last updated

Aug 4, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ashraf Affan, M.D.NPI 1477538593

Title

President

Phone

(904) 616-2772

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Ashraf Ali Affan, MD

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1477538593
  Authorized official Same address or phone

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

{
    "created_epoch": "1470268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470268800000",
    "number": "1457805756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD",
            "address_2": "SUITE 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585212",
            "telephone_number": "904-616-2772",
            "fax_number": "904-674-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13241 BARTRAM PARK BLVD",
            "address_2": "SUITE 209",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585212",
            "telephone_number": "904-616-2772",
            "fax_number": "904-674-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC INNOVATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-04",
        "last_updated": "2016-08-04",
        "status": "A",
        "authorized_official_last_name": "AFFAN",
        "authorized_official_first_name": "ASHRAF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-616-2772",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME86016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Associates of Julington Creek
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• Pediatric Associates of NE Florida, LLC (Jacksonville Pediatric Associates)
• Pediatric Care Centers, LLC (24/7 Pediatric Care Centers)
• Pediatric Center for Excellence, LLC
• Pediatric Services of America, Inc. (PSA Healthcare)
• Pediatric Services of America, LLC (Aveanna Healthcare)
• Pediatric Services of America, LLC (Aveanna Healthcare)
• Pediatric Services of America, LLC (Aveanna Heatlhcare)
• Pediatric Smiles, Inc

• Pediatrics Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2016; 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.