Samuel Santelices, MD
Individual provider Active NPI Pediatrics Physician · Lake City, FL
NPI 1669476552 · NPPES record last updated Jun 18, 2025
Key facts
- NPI
- 1669476552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- ME87551 (FL)
- Practice address
- 1859 SW Newland Way
Lake City, FL 32025-6966 - Phone
- (386) 758-0003
- Fax
- (386) 755-7940
- NPI assigned
- Jun 8, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Owned or controlled facilities with NPI records 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| North Florida Pediatrics, PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) W-2 Managing Employee |
Jan 1, 2010 Jan 1, 2010 Jan 1, 2025 |
| Acute Care Pediatrics,PA |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) Operational/Managerial Control |
May 1, 2024 May 1, 2024 |
| Acute Care Pediatrics of Palm Coast PA |
Rural health clinic | 5% Or Greater Indirect Ownership Interest (100%) Operational/Managerial Control |
May 1, 2024 May 1, 2024 |
| North Florida Pediatrics, PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) W-2 Managing Employee |
Jan 1, 2010 Jan 1, 2010 Jan 1, 2025 |
| North Florida Pediatrics, PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) W-2 Managing Employee (100%) |
Nov 28, 1995 Nov 28, 1995 Nov 28, 1995 |
| North Florida Pediatrics, PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) W-2 Managing Employee (100%) |
Jan 1, 2010 Jan 1, 2010 Jan 1, 2010 |
| North Florida Pediatrics, PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest Corporate Officer W-2 Managing Employee |
Jan 1, 2010 Jan 1, 2010 Jan 1, 2010 |
| North Florida Pediatrics, PA |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) W-2 Managing Employee (100%) |
Jan 1, 2010 Jan 1, 2010 Jan 1, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040602000651 | FL | Practitioner - Pediatric Medicine | 5092797274 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Florida Pediatrics, PA | Pediatrics | Current |
Accepting new patients |
| North Florida Pediatrics PA | Pediatrics | Current |
Accepting new patients |
| Acute Care Pediatrics,PA | Pediatrics | Current |
Accepting new patients |
| North Florida Pediatrics, PA. | Pediatrics | Past | Accepting new patients |
| North Florida Pediatrics, PA | Pediatrics | Past | Accepting new patients |
| Acute Care Pediatrics of Palm Coast, PA | Pediatrics | Past | Accepting new patients |
Locations
2220 N Young Blvd
Chiefland, FL 32626
Phone (352) 221-7337
149 NE 241st St
#A
Cross City, FL 32628
Phone (352) 498-3337
9770 Old Baymeadows Rd
Ste 101
Jacksonville, FL 32256
Phone (386) 758-0003
4051 Atlantic Blvd
Jacksonville, FL 32207
Phone (904) 393-4700
1117 US Highway 41 NW
#B
Jasper, FL 32052
Phone (386) 792-3864
1859 SW Newland Way
Lake City, FL 32025
Phone (386) 758-0003
1101 Ohio Ave S
Live Oak, FL 32064
Phone (386) 339-1060
Interoperability endpoints
- samuel.santelices.p1@direct.nfpeds.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME87551 | FL | Yes |
Addresses
Primary practice location
1859 SW Newland Way
Lake City, FL 32025-6966
Mailing address
1859 SW Newland Way
Lake City, FL 32025-6966
Phone (386) 758-0003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 267374600 | Medicaid | FL |
Other providers in Lake City, FL
- William David Sanders
- Taylor J Sansone
- Robert J Sansouci III III
- Marisol Isabel Santamarina
- Pamela G Santelices
- Benjamin Malabanan Santos
- Katie Sapir
- Ashley Sapp-Edwards
- Lanitra P Sapp
- Glen Rodney Saucier
All providers in Lake City, FL · Pediatrics Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.