NPIMap

Organization Active NPI

Pediatric Associates of Tampa Bay, LLC

  • Pediatrics Physician
  • Trinity, FL
National Provider Identifier
1912345497
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 TAMPA BAY, LLC
Practice address
10710 State Road 54 Ste 108
Trinity, FL 34655-2263
Phone
(727) 376-4040
Fax
(727) 376-8824
NPI assigned
Jun 6, 2013
Last updated
Aug 25, 2020By the provider in NPPES
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
Dr. Peter J Shulman, MD
Title
Ceo
Phone
(954) 965-7322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

10710 State Road 54 Ste 108
Trinity, FL 34655-2263

Mailing address

900 S Pine Island Rd
800
Plantation, FL 33324-3920
Phone (954) 967-6400

Other identifiers 1

IdentifierTypeStateIssuer
008927601MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Associates of Tampa Bay LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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": "1370476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598313600000",
    "number": "1912345497",
    "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": "954-967-6400",
            "fax_number": "954-965-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10710 STATE ROAD 54 STE 108",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346552263",
            "telephone_number": "727-376-4040",
            "fax_number": "727-376-8824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF TAMPA BAY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ASSOCIATES HOLDING COMPANY",
        "enumeration_date": "2013-06-06",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "SHULMAN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-965-7322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008927601",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinity, 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.