PEDIATRIC SPECIALTY GROUP, INC (NPI# 1003306093) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003306093 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC SPECIALTY GROUP, INC |
| Other Organization Name | NICKLAUS CHILDREN'S COCONUT CREEK CARE CENTER |
| Practice Address |
6370 N State Road 7 Ste 100 Coconut Creek FL 33073 |
| Mailing Address |
3100 Sw 62nd Ave Miami FL 33155-3009 |
| Practice Telephone | 9543217762 |
| Practice Fax Number | 9543219596 |
| Mailing Telephone | 7866245876 |
| Mailing Fax Number | 7866242688 |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-09-26 |
| Authorized Official Name | RAIZA BEATRIZ VIDAURRAZAGA (SR. PROVIDER RELATIONS SPECIALIST) |
| Authorized Official Telephone | 7866242186 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0204X |
Pediatrics Specialization: Pediatric Emergency Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0205X |
Pediatrics Specialization: Pediatric Endocrinology |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0210X |
Pediatrics Specialization: Pediatric Nephrology |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0216X |
Pediatrics Specialization: Pediatric Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 2085P0229X |
Radiology Specialization: Pediatric Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 282NC2000X |
General Acute Care Hospital Specialization: Children |
Hospitals | ||
| N | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
Ambulatory Health Care Facilities | ||
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 010060900 | 05 |
| Other Name | Type Code |
|---|---|
| Nicklaus Children's Coconut Creek Care Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013577246 | Pediatric Specialty Group, Inc | Pediatrics | 4410 W 16th Ave Ste 60, Hialeah, FL 33012-7194 | 2019-06-19 |
| 1598229890 | Pediatric Specialty Group, Inc | Pediatrics | 3228 Sw Martin Downs Blvd, Palm City, FL 34990-2679 | 2019-01-31 |
| 1679037790 | Pediatric Specialty Group, Inc | Pediatrics | 3445 Nw 7th St, Miami, FL 33125-4013 | 2019-01-23 |
| 1013456144 | Pediatric Specialty Group, Inc | Pediatrics | 3100 Sw 62nd Ave, Suite- 4 Tower Nicu, Miami, FL 33155-3009 | 2017-02-22 |
| Street Address |
6370 N STATE ROAD 7 STE 100 |
| City | COCONUT CREEK |
| State | FL |
| Zip Code | 33073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649434093 | Mark M Fortney | Physician Assistant | 6370 N State Road 7 Ste 100, Coconut Creek, FL 33073-3606 | 2008-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831796275 | Mireille Alexis | Prosthetist | 4376 Fl-7, Coral Springs, FL 33073 | 2020-10-08 |
| 1811506173 | Josee Helene Beaudry | Registered Nurse | 7700nw 48th Ave, Coconut Creek, FL 33073 | 2020-07-23 |
| 1700426210 | Stanback Enterprises LLC | Behavioral Analyst | 5561 North Winston Park Boulevard, Apartment 203, Coconut Creek, FL 33073 | 2020-01-13 |
| 1336701101 | Elissa N Tricoche | Behavior Technician | 5500 Hillsboro Blvd, Suite 208, Coconut Creek, FL 33073 | 2019-07-02 |
| 1124683677 | Vedrine Healthcare, LLC | Family Medicine | 6350 Nw 41st Terrace, Pompano Beach, FL 33073 | 2019-05-09 |
| 1518420058 | Balance Wellness Therapy Inc | Massage Therapist | 5853 Nw 40th Ave, Coconut Creek, FL 33073 | 2019-04-11 |
| 1497231336 | Brcastrong Corp | Health Educator | 4535 Nw 50th Court, Coconut Creek, FL 33073 | 2018-07-13 |
| 1851885156 | Cintia D Kopecny | Dentist | 5350 W Hillsboro Blvd Ste 201, Coconut Creek, FL 33073 | 2018-06-20 |
| 1720576721 | Sherell Breus | Driver | 4911 W Sample Rd, Coconut Creek, FL 33073 | 2018-04-25 |
| 1376053769 | Christiane Santana | Acupuncturist | 2300 W Sample Rd Ste 213, Pompano Beach, FL 33073 | 2017-10-11 |
| Find all providers in zip 33073 | ||||
| Taxonomy Code | 207XP3100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Pediatric Orthopaedic Surgery |
| An orthopedic surgeon who has additional training and experience in diagnosing, treating and managing musculoskeletal problems in infants, children and adolescents. These may include limb and spine deformities (such as club foot, scoliosis); gait abnormalities (limping); bone and joint infections; broken bones. |
| Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952662355 | Scoliosis & Pediatric Ortho Pa | Orthopaedic Surgery | 6370 N State Road 7, Suite 100, Coconut Creek, FL 33073-3606 | 2012-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447898580 | North Broward Hospital District | Orthopaedic Surgery | 3100 Coral Hills Dr Ste 202, Coral Springs, FL 33065-4139 | 2019-12-19 |
| 1144422486 | Hallandale Beach Orthopedics, Inc. | Orthopaedic Surgery | 1250 E Hallandale Beach Blvd Ste 700, Hallandale Beach, FL 33009-4641 | 2007-05-31 |
| 1427259076 | Davida Packer | Orthopaedic Surgery | 901 45th St Kimmel Bldg, West Palm Beach, FL 33407-2413 | 2007-05-30 |
| 1124249511 | Jeffrey Alan Crastnopol | Orthopaedic Surgery | 3405 Saddlebrook Ln, Weston, FL 33331-3034 | 2007-05-01 |
| 1386786838 | Pediatric Orthopedics of Southwest Florida | Orthopaedic Surgery | 15821 Hollyfern Court, Fort Myers, FL 33908 | 2007-02-13 |
| 1134290414 | Luis Edgardo Kortright | Orthopaedic Surgery | 4600 N Habana Ave Ste 6, Tampa, FL 33614-7123 | 2006-11-10 |
| 1205862745 | Raymund Woo | Orthopaedic Surgery | 2501 N Orange Ave Ste 514, Orlando, FL 32804-4674 | 2006-06-25 |
| 1568424075 | David Siambanes | Orthopaedic Surgery | 3003 E. Dr. Martin Luther King Jr. Blvd., Mab-3rd Floor, Tampa, FL 33607-6307 | 2006-04-03 |
| 1740282292 | Randolph Cohen | Orthopaedic Surgery | 5830 Coral Ridge Dr Ste 207, Coral Springs, FL 33076 | 2005-08-15 |
| 1851394746 | Timothy Michael Bradley | Orthopaedic Surgery | 602 Vonderburg Dr, Suite 103, Brandon, FL 33511-5900 | 2005-05-24 |
| Find all providers with the same taxonomy | ||||
| City | COCONUT CREEK |
| Zip Code | 33073 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.