Community Care Pediatrics PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

COMMUNITY CARE PEDIATRICS PA

Practice address

3670 US 1 South Ste 300 B
Saint Augustine, FL 32086

Phone

(904) 479-9501

Fax

(904) 217-0524

NPI assigned

Apr 28, 2012

Organization subpart

No

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

Authorized official

Name

Luis Anderson, MDNPI 1649337635

Title

MD/President/Owner

Phone

(904) 479-9501

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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.

• Luis M Anderson, M.D.

  • Pediatrics Physician
  • St Augustine, FL
  • NPI 1649337635
  NPD Authorized official

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

{
    "created_epoch": "1335571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581638400000",
    "number": "1639437569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 US 1 SOUTH STE 300 B",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "32086",
            "telephone_number": "904-479-9501",
            "fax_number": "904-217-0524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 US 1 SOUTH STE 300 B",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "32086",
            "telephone_number": "904-479-9501",
            "fax_number": "904-217-0524"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "885 State Road 20",
            "address_purpose": "LOCATION",
            "city": "Interlachen",
            "state": "FL",
            "postal_code": "321482430",
            "country_code": "US",
            "telephone_number": "386-643-0400",
            "fax_number": "386-350-0398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY CARE PEDIATRICS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-28",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "LUIS",
        "authorized_official_title_or_position": "MD/PRESIDENT/OWNER",
        "authorized_official_telephone_number": "904-479-9501",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269304600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in St Augustine, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; 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.