NPIMap

Organization Active NPI

Children's Express Care Clinic

Doing business as Excel Pediatrics

  • Pediatrics Physician
  • Saint Johns, FL
National Provider Identifier
1538735246
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILDREN'S EXPRESS CARE CLINIC
Doing business as
Excel Pediatrics
Practice address
135 Durbin Station CT Unit 503
St Johns, FL 32259-9370
Phone
(904) 519-0008
NPI assigned
Jun 2, 2021
Last updated
Jun 8, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CHILDREN'S EXPRESS CARE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Authorized official

Name
Suwarna M Tilak, MDNPI 1174546584
Title
President
Phone
(904) 519-0008

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

135 Durbin Station CT Unit 503
St Johns, FL 32259-9370

Mailing address

135 Durbin Station CT Unit 503
St Johns, FL 32259-9370
Phone (904) 519-0008

Other identifiers 1

IdentifierTypeStateIssuer
004548500MedicaidFL

Other names 1

  • Excel Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Children's Express Care Clinic4 organizations share this tax ID, including this one
Part of
Children's Express Care Clinic

Other organizations with this tax ID 3

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

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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1538735246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 DURBIN STATION CT UNIT 503",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322599370",
            "telephone_number": "904-519-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 DURBIN STATION CT UNIT 503",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322599370",
            "telephone_number": "904-519-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S EXPRESS CARE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S EXPRESS CARE CLINIC",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "TILAK",
        "authorized_official_first_name": "SUWARNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-519-0008",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004548500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Excel Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Johns, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.