NPIMap

Organization Active NPI

Pediatric Specialty Group, Inc

Doing business as Pediatric Specialists of America At Palm City

  • Pediatrics Physician
  • Palm City, FL
National Provider Identifier
1598229890
Registry record updated Jan 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC SPECIALTY GROUP, INC
Doing business as
Pediatric Specialists of America At Palm City
Practice address
3228 SW Martin Downs Blvd
Palm City, FL 34990-2679
Phone
(772) 286-8133
NPI assigned
Jan 31, 2019
Last updated
Jan 31, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC SPECIALTY GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 31, 2019

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

Authorized official

Name
Raiza Beatriz Vidaurrazaga
Title
Sr. Provider Relations Specialist
Phone
(786) 624-2186

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary
Pediatric Clinical & Laboratory Immunology Physician 2080I0007X NU
Pediatric Cardiology Physician 2080P0202X NU
Pediatric Endocrinology Physician 2080P0205X NU
Pediatric Gastroenterology Physician 2080P0206X NU

Addresses

Primary practice location

3228 SW Martin Downs Blvd
Palm City, FL 34990-2679

Mailing address

3100 SW 62ND Ave
Miami, FL 33155-3009
Phone (772) 286-8133

Other names 1

  • Pediatric Specialists of America At Palm City Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170329002645 FL Part B Supplier - Clinic/Group Practice 5395020507 Receives reassigned benefits from 68 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weston, FL; Plantation, FL; Palmetto Bay, FL; Palm City, FL; Miami, FL; Hialeah, FL; Fort Lauderdale, FL; Coral Springs, FL…

Other NPIs on the same Medicare enrollment 32

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 32

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

3228 SW Martin Downs Blvd
Palm City, FL 34990
Phone (772) 266-9355

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 3

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": "1548892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548892800000",
    "number": "1598229890",
    "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": "772-286-8133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3228 SW MARTIN DOWNS BLVD",
            "city": "PALM CITY",
            "state": "FL",
            "postal_code": "349902679",
            "telephone_number": "772-286-8133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPECIALTY GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC SPECIALTY GROUP, INC.",
        "enumeration_date": "2019-01-31",
        "last_updated": "2019-01-31",
        "status": "A",
        "authorized_official_last_name": "VIDAURRAZAGA",
        "authorized_official_first_name": "RAIZA",
        "authorized_official_middle_name": "BEATRIZ",
        "authorized_official_title_or_position": "SR. PROVIDER RELATIONS SPECIALIST",
        "authorized_official_telephone_number": "786-624-2186"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080I0007X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Clinical & Laboratory Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Specialists of America At Palm City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palm City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; 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.