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BEACHSIDE PEDIATRIC ASSOCIATES, P.A.
NPI 1225634462
Clinic/Center - Primary Care in Niceville, FL

Active since December 10, 2020CLIA 10D2221356 · Waiver
490 HIGHWAY 85 N, NICEVILLE, FL 32578(850) 419-2691(850) 353-2142 Get Directions Write a Review

NPPES record last updated: January 21, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jan 21, 2021, Dec 16, 2020, Dec 10, 2020 (3 updates tracked since 2020).

About Beachside Pediatric Associates, P.a. NPPES

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

BEACHSIDE PEDIATRIC ASSOCIATES, P.A. (NPI 1225634462) is a healthcare organization registered as a primary care in Niceville, Florida and active in the NPI registry since December 2020. The organization holds a CLIA Waiver certificate valid through April 19, 2027 and lists Clayton Covell Lancaster, Project Manager, as its authorized official.

NPPES Registry Identity

NPI1225634462
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameBEACHSIDE PEDIATRIC ASSOCIATES, P.A.
Location Address490 HIGHWAY 85 NNiceville, FL 32578-1010
Mailing Address1590 Ruckel DrNiceville, FL 32578-1603 · (850) 621-5058
Phone(850) 419-2691
Fax(850) 353-2142
Organization SubpartNo
Authorized OfficialClayton Covell LancasterProject Manager · (850) 758-8331
Enumeration DateDecember 10, 2020
Last NPPES UpdateJanuary 21, 20213 updates tracked since enumeration
NPPES CertifiedJanuary 21, 2021
✔ NPI 1225634462 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
490 HIGHWAY 85 N, Niceville, FL 32578
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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 10D2221356

Beachside Pediatric Associates PA · Niceville, FL
Active · expires Apr 19, 2027
CLIA Number10D2221356
Laboratory TypePhysician Office
Certificate Effective DateApril 20, 2025
Certificate Expiration DateApril 19, 2027
Laboratory DirectorLaltha Vadlamani-Simmers
Laboratory Phone(850) 424-6208
Laboratory LocationBeachside Pediatric Associates PA490 Hwy 85 N Ste A, Niceville, FL 32578
CLIA data matches this NPI record on: Address 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.

NORTHWEST FLORIDA CARDIOLOGY LLC
Internal Medicine (Cardiovascular Disease)
490 HIGHWAY 85 N, STE A & B
NICEVILLE, FL 32578
Okaloosa County (850) 678-6501

Frequently Asked Questions

What is BEACHSIDE PEDIATRIC ASSOCIATES, P.A.'s NPI number?

The NPI number assigned to this healthcare provider is 1225634462, enumerated as an "organization" on December 10, 2020.

Where is the provider located?

The provider is located at 490 HIGHWAY 85 N NICEVILLE, FL 32578 and the phone number is (850) 419-2691.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QP2300X and a focus in Primary Care.