St. Augustine Pediatric Associates, PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME78696 Issued in FL

Legal business name

ST. AUGUSTINE PEDIATRIC ASSOCIATES, PA

Practice address

1301 Plantation Island Dr S
Suite 106B
St Augustine, FL 32080-3108

Phone

(904) 461-8906

Fax

(904) 461-7575

NPI assigned

May 18, 2007

Reactivated

Aug 17, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Michael Soberano, MDNPI 1477596377

Title

Owner

Phone

(904) 824-5437

Specialties & licenses 1

Addresses

Tax ID family

St Augustine Pediatric Associates PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• St. Augustine Pediatric Associates, PA

  • Pediatrics Physician
  • St Augustine, FL
  • NPI 1447461421
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Maxino Soberano, MD

  • Pediatrics Physician
  • St Augustine, FL
  • NPI 1477596377
  NPD Authorized official

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439769600000",
    "number": "1629286299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "SUITE 106B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-461-8906",
            "fax_number": "904-461-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PLANTATION ISLAND DR S",
            "address_2": "SUITE 106B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803108",
            "telephone_number": "904-461-8906",
            "fax_number": "904-461-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. AUGUSTINE PEDIATRIC ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2015-08-17",
        "deactivation_date": "2011-11-22",
        "reactivation_date": "2015-08-17",
        "status": "A",
        "authorized_official_last_name": "SOBERANO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-824-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME78696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Augustine Foot & Ankle, Inc
• St. Augustine Foot & Ankle, Inc
• St. Augustine Foot & Ankle, Inc.
• St. Augustine Group Homes, Inc
• St. Augustine Pediatric Associates, PA
• St. Augustine Surgery Center
• St. Augustine Therapy LLC
• St. John'S Pediatrics, P.a.
• St. John'S Pediatrics, PA
• St. Johns County Council on Aging Inc.

• Pediatrics Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; 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.