NPIMap

Organization Active NPI

Pediatric Associates of Northeast Florida, LLC

Doing business as Jacksonville Pediatric Associates

  • Pediatrics Physician
  • Saint Johns, FL
National Provider Identifier
1720619422
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF NORTHEAST FLORIDA, LLC
Doing business as
Jacksonville Pediatric Associates
Practice address
155 Bartram Market Dr Ste 120
St Johns, FL 32259-4582
Phone
(904) 650-2193
Fax
(904) 201-6350
NPI assigned
Jan 31, 2020
Last updated
May 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Authorized official

Name
Patricia Corsiatto
Title
Director
Phone
(954) 965-7331

Specialties & licenses 1

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

Addresses

Primary practice location

155 Bartram Market Dr Ste 120
St Johns, FL 32259-4582

Mailing address

900 S Pine Island Rd Ste 800
Plantation, FL 33324-3923
Phone (954) 967-6400

Other identifiers 1

IdentifierTypeStateIssuer
011962603MedicaidFL

Other names 1

  • Jacksonville Pediatric Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jacksonville Pediatric Associates6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1720619422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S PINE ISLAND RD STE 800",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243923",
            "telephone_number": "954-967-6400",
            "fax_number": "954-965-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 BARTRAM MARKET DR STE 120",
            "city": "ST JOHNS",
            "state": "FL",
            "postal_code": "322594582",
            "telephone_number": "904-650-2193",
            "fax_number": "904-201-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF NORTHEAST FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-31",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "CORSIATTO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-965-7331"
    },
    "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": "011962603",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville Pediatric Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jacksonville Pediatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Johns, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.