Active NPI
Santo Nino Pediatric Clinic, PC
- Pediatrics Physician
- Augusta, GA
National Provider Identifier
1760431605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5444457 | Other | GA | CCN(NETWORK) |
| GPA837 | Medicaid | SC | |
| 10942549 | Other | GA | CAROLINA CARE PLAN |
| 003683189A | Medicaid | GA |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Pediatrics Physician
- Augusta, GA
- NPI 1821057043
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.