NPIMap

Organization Active NPI

Pediatric Associates of NE Florida, LLC

  • Pediatrics Physician
  • Jacksonville, FL
National Provider Identifier
1801216155
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC ASSOCIATES OF NE FLORIDA, LLC
Practice address
4972 Town Center Pkwy # 301
Jacksonville, FL 32246
Phone
(904) 642-6100
Fax
(904) 642-5154
NPI assigned
Apr 24, 2014
Organization subpart
Yes
Parent organization
PEDIATRIC ASSOCIATES HOLDING COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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) 967-6400

Specialties & licenses 1

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

Addresses

Primary practice location

4972 Town Center Pkwy # 301
Jacksonville, FL 32246

Mailing address

900 S Pine Island Rd
800
Plantation, FL 33324-3920
Phone (904) 642-6100

Other identifiers 1

IdentifierTypeStateIssuer
011962600MedicaidFL

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": "1398297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598313600000",
    "number": "1801216155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S PINE ISLAND RD",
            "address_2": "800",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333243920",
            "telephone_number": "904-642-6100",
            "fax_number": "904-642-5154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4972 TOWN CENTER PKWY # 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32246",
            "telephone_number": "904-642-6100",
            "fax_number": "904-642-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF NE FLORIDA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ASSOCIATES HOLDING COMPANY",
        "enumeration_date": "2014-04-24",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "CORSIATTO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "954-967-6400"
    },
    "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": "011962600",
            "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 Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; 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.