KIDSVILLE PEDIATRICS III, P.A.
NPI 1215901723
General Practice in Clermont, FL
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
Specialties & Licenses 2
Other Identifiers 3
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kidsville Pediatrics Iii, P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Kidsville Pediatrics III, P.A., which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, FLFrequently 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.
Is Kidsville Pediatrics III, P.A. enrolled in Medicare?
Yes. Kidsville Pediatrics III, P.A. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Kidsville Pediatrics III, P.A.?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in General Practice, reassign their Medicare billing to Kidsville Pediatrics III, P.A.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 21 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.
# Kidsville Pediatrics Iii, P.a. · NPI 1215901723
General Practice organization in Clermont, Florida. Organization record, active in the CMS NPPES registry since February 14, 2006.
## Identity
- **NPI:** 1215901723 (Entity type: Organization)
- **Enumerated:** February 14, 2006
- **Primary specialty:** General Practice · taxonomy 208D00000X
- **Organization subpart:** No
- **Authorized official:** Victor Pantoja Jr., ADMINISTRATOR
## Practice location
- **Address:** 1804 OAKLEY SEAVER BLVD, SUITE-C, Clermont, FL 34711-1925
- **Phone:** (352) 242-1021 · **Fax:** (352) 242-1104
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (General Practice) reassign Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 22, 2025
- **Other identifiers:** Medicaid 001599400 (FL); Medicaid 125226800 (FL); Other FL206A (FL)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1215901723) · Data from the CMS NPPES public registry.