Active NPI
Tavares Pediatrics Inc
- Rural Health Clinic/Center
- Tavares, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- License
- ME72542
- Legal business name
- TAVARES PEDIATRICS INC
- Practice address
- 2754 Dora Ave
Tavares, FL 32778-4970 - Phone
- (352) 394-3929
- Fax
- (352) 394-6446
- NPI assigned
- Sep 7, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mohammad Afzal
- Title
- MD
- Phone
- (352) 394-3929
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | ME72542 | FL | Primary |
Addresses
Primary practice location
2754 Dora Ave
Tavares, FL 32778-4970
Mailing address
2754 Dora Ave
Tavares, FL 32778-4970
Phone (352) 508-5176
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004771000 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111206000568 | FL | Part A Provider - Rural Health Clinic | 3779758578 | Practice locations: Tavares, FL |
Rural health clinic certification: CCN 103928
- Legal name
- TAVARES PEDIATRICS INC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 2, 2012
- Last certification
- May 9, 2024
- Ownership / control type
- 1B
- Organization structure
- Corporation
- Incorporated
- Sep 6, 2011 in FL
- Enrollment address
- 2754 Dora Ave
Tavares, FL 32778-4970
National Provider Directory
National Provider Directory- Tax ID family
- Tavares Pediatrics Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Primary Care Clinic/Center
- Tavares, FL
- NPI 1629641923
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Mohammad Afzal | 5% Or Greater Direct Ownership Interest | Sep 1, 2011 | 100% |
| Corporate Officer | Sep 1, 2011 | 100% | |
| W-2 Managing Employee | Sep 1, 2011 | ||
| Tavares Pediatrics Inc | 5% Or Greater Direct Ownership Interest | Sep 6, 2011 | 100% |
| Operational/Managerial Control | Sep 2, 2011 | 100% | |
| Jessica Powers | W-2 Managing Employee | Feb 1, 2014 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Pediatrics Physician
- Clermont, FL
- NPI 1669411161
5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pediatrics Physician
- Clermont, FL
- NPI 1669411161
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315353600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1737504000000",
"number": "1679854343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2754 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "327784970",
"telephone_number": "352-508-5176",
"fax_number": "352-508-5179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2754 DORA AVE",
"city": "TAVARES",
"state": "FL",
"postal_code": "327784970",
"telephone_number": "352-394-3929",
"fax_number": "352-394-6446"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TAVARES PEDIATRICS INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-09-07",
"last_updated": "2025-01-22",
"certification_date": "2025-01-22",
"status": "A",
"authorized_official_last_name": "AFZAL",
"authorized_official_first_name": "MOHAMMAD",
"authorized_official_title_or_position": "MD",
"authorized_official_telephone_number": "352-394-3929",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "FL",
"license": "ME72542",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004771000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tavares, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.