NPIMap

Organization Active NPI

Andres R Villar MD

  • Pediatrics Physician
  • Glen St Mary, FL
National Provider Identifier
1689768772
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
ANDRES R VILLAR MD
Practice address
6704 E Mount Vernon St
Glen St Mary, FL 32040-5050
Phone
(904) 259-7420
Fax
(904) 259-8366
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Andres R Villar, MDNPI 1164421855
Title
Administrator
Phone
(386) 755-5044

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)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

6704 E Mount Vernon St
Glen St Mary, FL 32040-5050

Mailing address

PO Box 606
Glen St Mary, FL 32040-0606
Phone (904) 653-1818

Other identifiers 1

IdentifierTypeStateIssuer
370861606MedicaidFL

Other names 1

  • Children's Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

122 Suwannee Ave SW
Branford, FL 32008

1419 S 6th St
Macclenny, FL 32063
Phone (904) 653-1822

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1689768772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 606",
            "city": "GLEN ST MARY",
            "state": "FL",
            "postal_code": "320400606",
            "telephone_number": "904-653-1818",
            "fax_number": "904-653-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6704 E MOUNT VERNON ST",
            "city": "GLEN ST MARY",
            "state": "FL",
            "postal_code": "320405050",
            "telephone_number": "904-259-7420",
            "fax_number": "904-259-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDRES R VILLAR MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "VILLAR",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-755-5044",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "370861606",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen St Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; 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.