NPIMap

Organization Active NPI

Atlantic Coast Pediatrics, M.D. P.a.

  • Pediatrics Physician
  • Merritt Island, FL
National Provider Identifier
1609825694
Registry record updated Sep 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ATLANTIC COAST PEDIATRICS, M.D. P.A.
Practice address
270 N Sykes Creek Pkwy
Unit 108
Merritt Island, FL 32953
Phone
(321) 452-1061
Fax
(321) 453-0866
NPI assigned
May 8, 2006
Last updated
Sep 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2016

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

Authorized official

Name
Dr. Luis A Gonzalez, M.D.NPI 1295793628
Title
President
Phone
(321) 452-1061

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

270 N Sykes Creek Pkwy
Unit 108
Merritt Island, FL 32953

Mailing address

PO Box 541216
Merritt Island, FL 32954-1216
Phone (321) 452-1061

Other identifiers 1

IdentifierTypeStateIssuer
054902900MedicaidFL

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
10D0872749Atlantic Coast Pediatrics270 N Sykes Creek Pkwy, Merritt Island, FL 32953Certificate of waiverSep 22, 2027

National Provider Directory

National Provider Directory

Locations

270 N Sykes Creek Pkwy
Ste 108
Merritt Island, FL 32953
Phone (321) 452-1061

Practitioners & affiliated clinicians

Practitioners 8

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": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1609825694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 541216",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329541216",
            "telephone_number": "321-452-1061",
            "fax_number": "321-453-0866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 N SYKES CREEK PKWY",
            "address_2": "UNIT 108",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "32953",
            "telephone_number": "321-452-1061",
            "fax_number": "321-453-0866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC COAST PEDIATRICS, M.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-452-1061",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054902900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; 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.