NPIMap

Organization Active NPI

Pediatric Health Care Alliance, PA

  • Pediatrics Physician
  • Riverview, FL
National Provider Identifier
1831865609
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC HEALTH CARE ALLIANCE, PA
Practice address
10729 Queens Town Dr
Riverview, FL 33579-7186
Phone
(813) 672-3497
Fax
(813) 741-2418
NPI assigned
Aug 20, 2021
Last updated
Aug 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Authorized official

Name
Debra S Gonzalez
Title
Coo
Phone
(813) 854-2003

Specialties & licenses 1

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

Addresses

Primary practice location

10729 Queens Town Dr
Riverview, FL 33579-7186

Mailing address

720 Brooker Creek Blvd Ste 215
Oldsmar, FL 34677-2937
Phone (813) 854-2003

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
10D1079772Pediatric Health Care Alliance PA10729 Queens Town Dr, Riverview, FL 33579Certificate of waiverFeb 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Health Care Alliance PA15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1831865609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 BROOKER CREEK BLVD STE 215",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346772937",
            "telephone_number": "813-854-2003",
            "fax_number": "813-436-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10729 QUEENS TOWN DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797186",
            "telephone_number": "813-672-3497",
            "fax_number": "813-741-2418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEALTH CARE ALLIANCE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-20",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "813-854-2003"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.