NPIMap

Organization Active NPI

Total Pediatric Healthcareii

  • Pediatrics Physician
  • Lakeland, FL
National Provider Identifier
1487880977
Registry record updated Jun 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME72163 Issued in FL
Legal business name
TOTAL PEDIATRIC HEALTHCAREII
Practice address
930 Marcum Rd
Lakeland, FL 33809-4308
Phone
(863) 815-3775
Fax
(863) 815-3765
NPI assigned
Jun 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2009

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

Authorized official

Name
Dr. Stewart A Grant, M.D.NPI 1497772412
Title
President
Phone
(863) 815-3775

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 ME72163 FL Primary

Addresses

Primary practice location

930 Marcum Rd
Lakeland, FL 33809-4308

Mailing address

5337 N Socrum Loop Rd
320
Lakeland, FL 33809-4256
Phone (863) 815-3775

Other identifiers 7

IdentifierTypeStateIssuer
2321757001OtherCIGNA
01106700OtherFLAMERIGROUP
10880601OtherFLCITRUSCAID
225385OtherWELLCARE
41515OtherFLBLUE CROSS BLUE SHIELD
132800OtherFLAETNA
268531100MedicaidFL

National Provider Directory

National Provider Directory

Locations

131 N Oakwood Ave
Brandon, FL 33510
Phone (813) 655-5106

930 Marcum Rd
Ste 12
Lakeland, FL 33809
Phone (863) 815-3775

3131 Lakeland Hills Blvd
Ste 4
Lakeland, FL 33805

203 Kerneywood St
Lakeland, FL 33803
Phone (863) 398-3870

Practitioners & affiliated clinicians

Practitioners 9

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": "1244592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1487880977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5337 N SOCRUM LOOP RD",
            "address_2": "320",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094256",
            "telephone_number": "863-815-3775",
            "fax_number": "863-815-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 MARCUM RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094308",
            "telephone_number": "863-815-3775",
            "fax_number": "863-815-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL PEDIATRIC HEALTHCAREII",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-10",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "STEWART",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-815-3775",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME72163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2321757001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01106700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CITRUSCAID",
            "identifier": "10880601",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "225385",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "41515",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "132800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268531100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; 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.