NPIMap

Organization Active NPI

Pediatric Specialty Group, Inc.

Doing business as Nicklaus Children's Pediatric Specialists at Palmetto Bay

  • Pediatrics Physician
  • Palmetto Bay, FL
National Provider Identifier
1518626985
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC SPECIALTY GROUP, INC.
Doing business as
Nicklaus Children's Pediatric Specialists at Palmetto Bay
Practice address
17615 SW 97TH Ave
Palmetto Bay, FL 33157-5636
Phone
(305) 669-6505
Fax
(305) 668-5591
NPI assigned
Dec 14, 2021
Organization subpart
Yes
Parent organization
PEDIATRIC SPECIALTY GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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

Authorized official

Name
Laura M Gaber
Title
Provider Relations Specialist
Phone
(786) 624-5747

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X

Addresses

Primary practice location

17615 SW 97TH Ave
Palmetto Bay, FL 33157-5636

Mailing address

3100 SW 62ND Ave
Miami, FL 33155-3009
Phone (305) 666-6511

Other names 1

  • Nicklaus Children's Pediatric Specialists at Palmetto Bay Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Specialty Group Inc76 organizations share this tax ID, including this one
Part of
Pediatric Specialty Group Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

17615 SW 97th Ave
Palmetto Bay, FL 33157
Phone (786) 268-1777

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1639440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1518626985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-666-6511",
            "fax_number": "305-662-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17615 SW 97TH AVE",
            "city": "PALMETTO BAY",
            "state": "FL",
            "postal_code": "331575636",
            "telephone_number": "305-669-6505",
            "fax_number": "305-668-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPECIALTY GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC SPECIALTY GROUP, INC.",
        "enumeration_date": "2021-12-14",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A",
        "authorized_official_last_name": "GABER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SPECIALIST",
        "authorized_official_telephone_number": "786-624-5747"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nicklaus Children's Pediatric Specialists at Palmetto Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmetto Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; 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.