Optimum Pediatric Services LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

OPTIMUM PEDIATRIC SERVICES LLC

Practice address

2058 Reserve Pkwy
McDonough, GA 30253-7433

Phone

(888) 668-7311

Fax

(888) 668-7314

NPI assigned

Dec 16, 2014

Last updated

Dec 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mirtha T Lafontant, RN

Title

Administrator

Phone

(888) 668-7311

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1548668098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2058 RESERVE PKWY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537433",
            "telephone_number": "888-668-7311",
            "fax_number": "888-668-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2058 RESERVE PKWY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537433",
            "telephone_number": "888-668-7311",
            "fax_number": "888-668-7314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUM PEDIATRIC SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "LAFONTANT",
        "authorized_official_first_name": "MIRTHA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "888-668-7311",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.