PEDIATRICS AND ADOLESCENT MEDICINE
NPI 1053360669
Pediatrics - Adolescent Medicine in Orange Park, FL
NPI Status: Active since May 09, 2006
Contact Information
2140 KINGSLEY AVE
STE.#10
ORANGE PARK, FL
ZIP 32073
Phone: (904) 276-0005
Fax: (904) 276-9202
- Organization
- Pediatrics
- Adolescent Medicine
- CLIA Number: 10D0931750
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 08-04-2027
About PEDIATRICS AND ADOLESCENT MEDICINE
This page provides the complete NPI Profile along with additional information for Pediatrics And Adolescent Medicine, a pediatrician established in Orange Park, Florida operating as a Pediatrics, focusing in adolescent medicine . The healthcare provider is registered in the NPI registry with number 1053360669 assigned on May 2006. The practitioner's primary taxonomy code is 2080A0000X with license number ME0067026 (FL). The provider is registered as an organization and their NPI record was last updated 18 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's is doing business as Pediatrics And Adolescent Medicine. The authorized official of this NPI record is Dr. Abdul Khalil Wallizada Md (Owner)
- NPI
- 1053360669
- Provider Legal Name
- ABDUL KHALIL WALLIZADA,MD
- Other Organization Name
- PEDIATRICS AND ADOLESCENT MEDICINE
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 2140 KINGSLEY AVE STE.#10 ORANGE PARK, FL 32073
- Location Phone
- (904) 276-0005
- Location Fax
- (904) 276-9202
- Mailing Address
- 2140 KINGSLEY AVE STE.#10 ORANGE PARK, FL 32073
- Mailing Phone
- (904) 276-0005
- Mailing Fax
- (904) 276-9202
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-09-2006
- Last Update Date
- 07-07-2008
- Code Navigator
A pediatrician like Pediatrics And Adolescent Medicine is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics Adolescent Medicine
- Taxonomy Code
- 2080A0000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- ME0067026
- License State
- FL
- Taxonomy Description
- A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| F90013 | MEDICARE UPIN (02) | FL | |
| 25991 | MEDICARE ID-TYPE UNSPECIFIED (04) | FL | |
| 376381100 | MEDICAID (05) | FL |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D0931750
- Facility Type
- Physician Office
- Certificate Effective Date
- August 05, 2025
- Certificate Expiration Date
- August 04, 2027
- Laboratory Director
- KHALIL A. WALLIZADA
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Pediatrics And Adolescent Medicine to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1053360669, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 51. The final step is to find the difference between that total and the next multiple of ten (60 - 51 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 51 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
ORANGE PARK, FL 32073
ORANGE PARK, FL 32073
ORANGE PARK, FL 32073
ORANGE PARK, FL 32073
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1053360669, enumerated as an "organization" on May 09, 2006.
The provider is located at 2140 KINGSLEY AVE STE.#10 ORANGE PARK, FL 32073 and the phone number is (904) 276-0005.
Pediatrics with taxonomy code 2080A0000X and a focus in Adolescent Medicine.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
