Organization Active NPI

Santo Nino Pediatric Clinic, PC

  • Pediatrics Physician
  • Augusta, GA
National Provider Identifier
1760431605
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SANTO NINO PEDIATRIC CLINIC, PC
Practice address
1722 Central Ave
Augusta, GA 30904-5737
Phone
(706) 855-7414
Fax
(706) 364-0554
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Mr. Alberto Rico Nafarrete
Title
Office Manager
Phone
(706) 855-7414

Specialties & licenses 1

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

Addresses

Primary practice location

1722 Central Ave
Augusta, GA 30904-5737

Mailing address

1722 Central Ave
Augusta, GA 30904-5737
Phone (706) 855-7414

Other identifiers 4

IdentifierTypeStateIssuer
5444457OtherGACCN(NETWORK)
GPA837MedicaidSC
10942549OtherGACAROLINA CARE PLAN
003683189AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1722 Central Ave
Augusta, GA 30904
Phone (706) 855-7414

Practitioners & affiliated clinicians

Practitioners 1

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": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1760431605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 CENTRAL AVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309045737",
            "telephone_number": "706-855-7414",
            "fax_number": "706-364-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 CENTRAL AVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309045737",
            "telephone_number": "706-855-7414",
            "fax_number": "706-364-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTO NINO PEDIATRIC CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "NAFARRETE",
        "authorized_official_first_name": "ALBERTO",
        "authorized_official_middle_name": "RICO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "706-855-7414",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN(NETWORK)",
            "identifier": "5444457",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPA837",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAROLINA CARE PLAN",
            "identifier": "10942549",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003683189A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; 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.