NPIMap

Organization Active NPI

Andres R Villar MD

  • Rural Health Clinic/Center
  • Alachua, FL
National Provider Identifier
1801980909
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ANDRES R VILLAR MD
Practice address
14861 NW US Highway 441
Alachua, FL 32615-8203
Phone
(386) 462-1911
Fax
(386) 462-1943
NPI assigned
Oct 3, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Andres R Villar, MD
Title
Administrator
Phone
(386) 755-5044

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
10D1009882Childrens Medical Center14861 NW Hwy 441, Alachua, FL 32615Certificate of waiverFeb 26, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070409000170 FL Part a Provider - Rural Health Clinic 5092623439 Practice locations: Alachua, FL

Rural health clinic certification: CCN 108960

Medicare enrollment files
Legal name
ANDRES R VILLAR MD
Doing business as
CHILDRENS MEDICAL CENTER - ALACHUA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2003
Last certification
Feb 26, 2020
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Apr 16, 1922 in FL
Enrollment address
14861 N W Hwy 441
Alachua, FL 32615-8203

All disclosed owners & managing parties 2

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andres Villar Individual 5% Or Greater Direct Ownership InterestPresident Mar 3, 2003 100%
Corporate OfficerPresident Apr 16, 1992 100%
W-2 Managing EmployeePresident Mar 3, 2003
Operational/Managerial ControlPresident Apr 16, 1992 100%
Rebecca Villar Individual W-2 Managing EmployeeAdministrator Aug 31, 2012

National Provider Directory

National Provider Directory
Tax ID family
Andres R Villar MD6 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.

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

14861 NW US Highway 441
Alachua, FL 32615-8203

Mailing address

PO Box 606
Glen St Mary, FL 32040-0606
Phone (904) 653-1818

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
660174000OtherFLMEDICAID RURAL HEALTH CLINIC

Other names 1

NPPES NPI Registry
  • Children's Medical Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 22, 2021.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1801980909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 606",
            "city": "GLEN ST MARY",
            "state": "FL",
            "postal_code": "320400606",
            "telephone_number": "904-653-1818",
            "fax_number": "904-653-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14861 NW US HIGHWAY 441",
            "city": "ALACHUA",
            "state": "FL",
            "postal_code": "326158203",
            "telephone_number": "386-462-1911",
            "fax_number": "386-462-1943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDRES R VILLAR MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "VILLAR",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "386-755-5044",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID RURAL HEALTH CLINIC",
            "identifier": "660174000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Children's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alachua, FL

Sources for this page

Verify at the official NPI Registry.