NPIMap

Organization Active NPI

Little Pine Pediatrics PLLC

  • Rural Health Clinic/Center
  • Madison, FL
National Provider Identifier
1497007553
Registry record updated Feb 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LITTLE PINE PEDIATRICS PLLC
Practice address
194 NE Hancock Ave
Madison, FL 32340-2546
Phone
(850) 253-2275
NPI assigned
Oct 12, 2012
Organization subpart
Yes
Parent organization
LITTLE PINE PEDIATRICSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 8, 2016

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

Authorized official

Name
Dr. Ronald Emerick Jr., DO
Title
Owner
Phone
(855) 577-5437

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X HCC10208 FL
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

194 NE Hancock Ave
Madison, FL 32340-2546

Mailing address

1702 S Jefferson St
Perry, FL 32348-5611
Phone (855) 577-5437

Other identifiers 1

IdentifierTypeStateIssuer
001165802MedicaidFL

Other names 1

  • Little Pine Pediatrics of Madison Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150602000388 FL Part A Provider - Rural Health Clinic 0244380152 Practice locations: Madison, FL

Rural health clinic certification: CCN 683820

Legal name
LITTLE PINE PEDIATRICS, PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 26, 2016
Last certification
Jan 26, 2016
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Mar 4, 2009 in FL
Enrollment address
194 NE Hancock Ave
Madison, FL 32340-2546

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Little Pine Pediatrics PLLC6 organizations share this tax ID, including this one
Part of
Little Pine Pediatrics PLLC

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kimberly Stroud Individual W-2 Managing EmployeePractice Manager Oct 18, 2013
Ronald Emerick Individual 5% Or Greater Direct Ownership Interest Jul 1, 2009 100%
Corporate OfficerMGRM Jul 1, 2009
Corporate DirectorMedical Director Jul 1, 2009
Operational/Managerial ControlAdministrator, Owner Jul 1, 2009
Elizabeth Driver Individual W-2 Managing EmployeeFront Office Manager Jul 18, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Ronald Emerick Jr., D.O.
    • Pediatrics Physician
    • Perry, FL
    • NPI 1205894425

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454889600000",
    "number": "1497007553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 S JEFFERSON ST",
            "city": "PERRY",
            "state": "FL",
            "postal_code": "323485611",
            "telephone_number": "855-577-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 NE HANCOCK AVE",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "323402546",
            "telephone_number": "850-253-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE PINE PEDIATRICS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LITTLE PINE PEDIATRICS",
        "enumeration_date": "2012-10-12",
        "last_updated": "2016-02-08",
        "status": "A",
        "authorized_official_last_name": "EMERICK",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-577-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "FL",
            "license": "HCC10208",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001165802",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Pine Pediatrics of Madison",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, FL

Sources for this page

Verify at the official NPI Registry.