Pediatric Foundations, PLLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

PEDIATRIC FOUNDATIONS, PLLC

Practice address

2624 Mt Isle Harbor Dr
Charlotte, NC 28214-5413

Phone

(727) 420-0267

NPI assigned

Apr 17, 2019

Last updated

May 28, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Linnette Richards, OTR/L

Title

Operations Manager

Phone

(727) 420-0267

Specialties & licenses 4

Addresses

Other identifiers 6

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

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559001600000",
    "number": "1932762622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2624 MT ISLE HARBOR DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282145413",
            "telephone_number": "727-420-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2624 MT ISLE HARBOR DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282145413",
            "telephone_number": "727-420-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC FOUNDATIONS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-05-28",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "LINNETTE",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "727-420-0267",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "18923",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1659420040",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTUM",
            "identifier": "006528",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "1659420040",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659420040",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REHAB PROVIDER NETWORK",
            "identifier": "2084",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric and Family Behavioral Health Acquisition Group PLLC (Pediatric and Family Behavioral Health PLLC)
• Pediatric Dentistry of Steele Creek
• Pediatric Endocrinology & Diabetes Specialists
• Pediatric Hair Solutions Corporation
• Pediatric Lung Center of Charlotte, PLLC
• Pediatric Promise Therapy Specialists, Inc (Pediatric Promise)
• Pediatric Services of America, LLC (Aveanna Healthcare)
• Pediatric Surgical Associates, P.a.

• Multi-Specialty Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Multi-Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2019; 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.