NPIMap

Organization Active NPI

North Florida Pediatrics, PA

  • Pediatric Adolescent Medicine Physician
  • Ponte Vedra, FL
National Provider Identifier
1609424217
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
NORTH FLORIDA PEDIATRICS, PA
Practice address
145 Hilden Road Suite 101
Ponte Vedra, FL 32081
Phone
(904) 393-4700
Fax
(904) 493-9700
NPI assigned
Aug 27, 2019
Last updated
Sep 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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

Authorized official

Name
Mr. Samuel Santelices, M.D.NPI 1669476552
Title
President/Ceo
Phone
(386) 758-0003

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
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

145 Hilden Road Suite 101
Ponte Vedra, FL 32081

Mailing address

1859 SW Newland Way
Lake City, FL 32025
Phone (386) 758-0003

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1088347North Florida Pediatrics PA145 Hilden Road Ste 101, Ponte Vedra, FL 32081Certificate of waiverOct 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Florida Pediatrics PA18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

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": "1566864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567468800000",
    "number": "1609424217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1859 SW NEWLAND WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "32025",
            "telephone_number": "386-758-0003",
            "fax_number": "386-755-4432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 HILDEN ROAD SUITE 101",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "904-393-4700",
            "fax_number": "904-493-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH FLORIDA PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-27",
        "last_updated": "2019-09-03",
        "status": "A",
        "authorized_official_last_name": "SANTELICES",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "386-758-0003",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.