NPIMap

Organization Active NPI

Sacred Heart Medical Group

  • Pediatrics Physician
  • Gulf Breeze, FL
National Provider Identifier
1679249403
Registry record updated Aug 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SACRED HEART MEDICAL GROUP
Practice address
15 Daniel Dr
Gulf Breeze, FL 32561-4418
Phone
(850) 932-5348
NPI assigned
Aug 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2021

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

Authorized official

Name
Jean Vallier
Title
Director
Phone
(850) 932-5348

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

15 Daniel Dr
Gulf Breeze, FL 32561-4418

Mailing address

4205 Belfort Rd Ste 4015
Jacksonville, FL 32216-3623
Phone (850) 932-5348

Other names 1

  • SHMG Pediatrics at Gulf Breeze Other name

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
10D1013845SHMG Gulf Breeze Pediatrics15 Daniel Drive, Gulf Breeze, FL 32561Certificate of waiverJun 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sacred Heart Medical Oncology Group98 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

15 Daniel Dr
Gulf Breeze, FL 32561
Phone (850) 746-0280

NPI Registry JSON

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

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1679249403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "850-932-5348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 DANIEL DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614418",
            "telephone_number": "850-932-5348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED HEART MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-20",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "VALLIER",
        "authorized_official_first_name": "JEAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "850-932-5348"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHMG Pediatrics at Gulf Breeze",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gulf Breeze, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; 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.