NPIMap

Organization Active NPI

Andres R Villar MD

  • Rural Health Clinic/Center
  • Lake City, FL
National Provider Identifier
1497754154
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ANDRES R VILLAR MD
Practice address
789 W Duval St
Lake City, FL 32055-3811
Phone
(386) 755-1546
Fax
(386) 755-2283
NPI assigned
Jul 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Dr. Andres R Villar, MDNPI 1164421855
Title
Administrator
Phone
(386) 755-5044

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
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

789 W Duval St
Lake City, FL 32055-3811

Mailing address

PO Box 606
Glen St Mary, FL 32040-0606
Phone (904) 653-1818

Other identifiers 1

IdentifierTypeStateIssuer
370861604OtherFLMEDICAID RURAL HEALTH CLINIC

Other names 1

  • Children's Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041014001098 FL Part A Provider - Rural Health Clinic 5092623439 Practice locations: Lake City, FL

Rural health clinic certification: CCN 103840

Legal name
ANDRES R VILLAR MD
Doing business as
CHILDREN'S MEDICAL CENTER- LAKE CITY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 29, 1993
Last certification
Jul 22, 2022
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Apr 16, 1992 in FL
Enrollment address
789 W Duval St
Lake City, FL 32055-3811

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory

Locations

14861 NW US Highway 441
Alachua, FL 32615
Phone (386) 462-1911

789 W Duval St
Lake City, FL 32055
Phone (386) 755-1546

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Andres Villar Individual 5% Or Greater Direct Ownership Interest Jan 1, 1992 100%
Corporate OfficerPresident Apr 16, 1992 100%
W-2 Managing EmployeePresident Oct 1, 2011
Operational/Managerial ControlPresident Apr 16, 1992 100%
Rebecca Villar Individual W-2 Managing EmployeeAdministrator Dec 20, 2021

Practitioners & affiliated clinicians

Practitioners 2

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": "1121385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1497754154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 606",
            "city": "GLEN ST MARY",
            "state": "FL",
            "postal_code": "320400606",
            "telephone_number": "904-653-1818",
            "fax_number": "904-653-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 W DUVAL ST",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320553811",
            "telephone_number": "386-755-1546",
            "fax_number": "386-755-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDRES R VILLAR MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-15",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "VILLAR",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-755-5044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID RURAL HEALTH CLINIC",
            "identifier": "370861604",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake City, FL

Sources for this page

Verify at the official NPI Registry.