NPIMap

Organization Active NPI

Pensacola Pediatrics, PA

  • Pediatrics Physician
  • Pensacola, FL
National Provider Identifier
1801649686
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PENSACOLA PEDIATRICS, PA
Practice address
5868 Creek Station Dr
Pensacola, FL 32504-8627
Phone
(850) 473-0100
Fax
(850) 473-0500
NPI assigned
Apr 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Authorized official

Name
Peter Heckathorn
Title
Administrator
Phone
(850) 473-0100

Specialties & licenses 1

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

Addresses

Primary practice location

5868 Creek Station Dr
Pensacola, FL 32504-8627

Mailing address

4951 Grande Dr
Pensacola, FL 32504-8965
Phone (850) 473-0100

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2308163Pensacola Pediatrics PA5868 Creek Station Drive, Pensacola, FL 32504Certificate of waiverJul 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pensacola Pediatrics PA9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

5868 Creek Station Dr
Pensacola, FL 32504
Phone (850) 471-5060

NPI Registry JSON

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

{
    "created_epoch": "1712707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1801649686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4951 GRANDE DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048965",
            "telephone_number": "850-473-0100",
            "fax_number": "850-473-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5868 CREEK STATION DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048627",
            "telephone_number": "850-473-0100",
            "fax_number": "850-473-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA PEDIATRICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-10",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "HECKATHORN",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-473-0100"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.