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ANCIENT CITY PEDIATRICS
NPI 1053598292
Pediatrics in Saint Augustine, FL

Active since January 30, 2008
1301 PLANTATION ISLAND DR S STE 104, SAINT AUGUSTINE, FL 32080(904) 461-1560(904) 461-4304 Get Directions Write a Review

NPPES record last updated: September 2, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 2, 2025, Jun 26, 2024 (2 updates tracked since 2024).

About Ancient City Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANCIENT CITY PEDIATRICS (NPI 1053598292), doing business as Dba Sunshine Pediatrics Of St Augustine, is a healthcare organization registered as a pediatrics in Saint Augustine, Florida and active in the NPI registry since January 2008. The organization lists Adrienne Mccoy, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1053598292
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameANCIENT CITY PEDIATRICS
Location Address1301 PLANTATION ISLAND DR S STE 104Saint Augustine, FL 32080-3108
Mailing Address1301 Plantation Island Dr S Ste 104Saint Augustine, FL 32080-3108 · (904) 461-1560 · Fax (904) 461-4304
Phone(904) 461-1560
Fax(904) 461-4304
Organization SubpartNo
Authorized OfficialAdrienne MccoyOffice Manager · (904) 461-1560
Enumeration DateJanuary 30, 2008
Last NPPES UpdateSeptember 2, 20252 updates tracked since enumeration
NPPES CertifiedOctober 23, 2024
✔ NPI 1053598292 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

1301 PLANTATION ISLAND DR S STE 104, Saint Augustine, FL 32080
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Other Names 1

Doing Business AsDba Sunshine Pediatrics Of St Augustine

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0267384

Ancient City Pediatrics · Saint Augustine, FL
Expired · Jul 25, 2026
CLIA Number10D0267384
Laboratory TypePhysician Office
Certificate Effective DateJuly 26, 2024
Certificate Expiration DateJuly 25, 2026
Laboratory DirectorMiguel A. Mas Jr
Laboratory Phone(904) 461-1560
Laboratory LocationAncient City Pediatrics1301 Plantation Island Dr S Ste 404, Saint Augustine, FL 32080
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ancient City Pediatrics's NPI number?

The NPI number for Ancient City Pediatrics is 1053598292. It was assigned to this organization in the NPPES registry on January 30, 2008. The provider is doing business as DBA Sunshine Pediatrics of St Augustine.

Where is Ancient City Pediatrics located?

Ancient City Pediatrics is located at 1301 Plantation Island Dr S Ste 104, Saint Augustine, FL 32080. The listed phone number is (904) 461-1560.

What is Ancient City Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

What insurance does Ancient City Pediatrics accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Ancient City Pediatrics as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ancient City Pediatrics was last updated on September 2, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.