NPIMap

Organization Active NPI

Ceron Pediatrics and Integrative Medicine

  • Pediatrics Physician
  • Jacksonville, FL
National Provider Identifier
1477043180
Registry record updated Apr 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CERON PEDIATRICS AND INTEGRATIVE MEDICINE
Practice address
1539 Parental Home Rd
Jacksonville, FL 32216-3009
Phone
(904) 338-0434
NPI assigned
May 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2019

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

Authorized official

Name
Lourdes Carolina Ceron Canas, MDNPI 1225068513
Title
Owner
Phone
(904) 891-9498

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

1539 Parental Home Rd
Jacksonville, FL 32216-3009

Mailing address

13758 Club Cove Dr
Jacksonville, FL 32225-5430
Phone (904) 891-9498

Other identifiers 1

IdentifierTypeStateIssuer
019982900MedicaidFL

National Provider Directory

National Provider Directory

Locations

1539 Parental Home Rd
Ste 1
Jacksonville, FL 32216

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9429/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555027200000",
    "number": "1477043180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13758 CLUB COVE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322255430",
            "telephone_number": "904-891-9498",
            "fax_number": "904-425-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1539 PARENTAL HOME RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163009",
            "telephone_number": "904-338-0434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERON PEDIATRICS AND INTEGRATIVE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2019-04-12",
        "status": "A",
        "authorized_official_last_name": "CERON CANAS",
        "authorized_official_first_name": "LOURDES",
        "authorized_official_middle_name": "CAROLINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-891-9498",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019982900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2019; 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.