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KIDSVILLE PEDIATRICS III, P.A.
NPI 1215901723
General Practice in Clermont, FL

Active since February 14, 2006CLIA 10D1035100 · Waiver
1804 OAKLEY SEAVER BLVD, SUITE-C, CLERMONT, FL 34711(352) 242-1021(352) 242-1104 Get Directions Write a Review

NPPES record last updated: January 22, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 7, 2022, Aug 8, 2019 (2 updates tracked since 2019).

About Kidsville Pediatrics Iii, P.a. NPPES

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

KIDSVILLE PEDIATRICS III, P.A. (NPI 1215901723) is a healthcare organization registered as a general practice in Clermont, Florida and active in the NPI registry since February 2006. The organization holds a CLIA Waiver certificate valid through December 20, 2026 and lists Victor M. Pantoja Jr., Administrator, as its authorized official.

NPPES Registry Identity

NPI1215901723
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameKIDSVILLE PEDIATRICS III, P.A.
Location Address1804 OAKLEY SEAVER BLVD, SUITE-CClermont, FL 34711-1925
Mailing Address1804 Oakley Seaver Blvd, Suite-cClermont, FL 34711-1925 · (352) 242-1021 · Fax (352) 242-1104
Phone(352) 242-1021
Fax(352) 242-1104
Organization SubpartNo
Authorized OfficialVictor M. Pantoja Jr.Administrator · (352) 242-1021
Enumeration DateFebruary 14, 2006
Last NPPES UpdateJanuary 22, 20252 updates tracked since enumeration
NPPES CertifiedJanuary 22, 2025
✔ NPI 1215901723 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedPediatricsTaxonomy 208000000X
1804 OAKLEY SEAVER BLVD, Clermont, FL 34711
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Other Identifiers 3

Medicaid001599400FL
Medicaid125226800FL
OtherFL206AFL · Medicare

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, Florida Blue (BlueCross BlueShield FL) and more.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 10D1035100

Kidsville Pediatrics III PA · Clermont, FL
Active · expires Dec 20, 2026
CLIA Number10D1035100
Laboratory TypePhysician Office
Certificate Effective DateDecember 21, 2024
Certificate Expiration DateDecember 20, 2026
Laboratory DirectorFrancelis I. Gonzales MD
Laboratory Phone(407) 646-2999
Laboratory LocationKidsville Pediatrics III PA1804 Oakley Seaver Dr Ste C, Clermont, FL 34711
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHRISTOPHER JAMES JOHNSON D.O.
Surgery
1804 OAKLEY SEAVER BLVD, SUITE A
CLERMONT, FL 34711
Lake County (352) 243-2622

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 Kidsville Pediatrics III, P.A.'s NPI number?

The NPI number for Kidsville Pediatrics III, P.A. is 1215901723. It was assigned to this organization in the NPPES registry on February 14, 2006.

Where is Kidsville Pediatrics III, P.A. located?

Kidsville Pediatrics III, P.A. is located at 1804 Oakley Seaver Blvd Suite-C, Clermont, FL 34711. The listed phone number is (352) 242-1021.

What is Kidsville Pediatrics III, P.A.'s specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Kidsville Pediatrics III, P.A. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1035100) is associated with this NPI, valid through December 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kidsville Pediatrics III, P.A. accept?

Health plans from Ambetter Health, Ambetter of Alabama, Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company) and Molina Healthcare and 1 other insurer list Kidsville Pediatrics III, P.A. 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 Kidsville Pediatrics III, P.A. was last updated on January 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.