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MAGNOLIA PEDIATRICS LLC
NPI 1356513964
Pediatrics in Lake City, FL

Active since March 24, 2008CLIA 10D1081090 · Waiver
1140 SW BASCOM NORRIS DR STE 104, LAKE CITY, FL 32025(386) 719-6500(386) 719-6503 Get Directions Write a Review

NPPES record last updated: October 5, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Magnolia Pediatrics Llc NPPES

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

MAGNOLIA PEDIATRICS LLC (NPI 1356513964) is a healthcare organization registered as a pediatrics in Lake City, Florida and active in the NPI registry since March 2008. The organization holds a CLIA Waiver certificate valid through March 9, 2028 and lists Bilal Khodr, Provider, as its authorized official.

NPPES Registry Identity

NPI1356513964
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameMAGNOLIA PEDIATRICS LLC
Location Address1140 SW BASCOM NORRIS DR STE 104Lake City, FL 32025-1329
Mailing Address1140 Sw Bascom Norris Dr Ste 104Lake City, FL 32025-1329 · (386) 719-6500 · Fax (386) 719-6503
Phone(386) 719-6500
Fax(386) 719-6503
Organization SubpartNo
Authorized OfficialBilal KhodrProvider · (386) 719-6500
Enumeration DateMarch 24, 2008
Last NPPES UpdateOctober 5, 2012
✔ NPI 1356513964 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in FL · ME72652
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.
1140 SW BASCOM NORRIS DR STE 104, Lake City, FL 32025
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Other Identifiers 1

Other061823792FL · Tricare

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, AvMed.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 10D1081090

Magnolia Pediatrics · Lake City, FL
Active · expires Mar 9, 2028
CLIA Number10D1081090
Laboratory TypePractitioner Other
Certificate Effective DateMarch 10, 2026
Certificate Expiration DateMarch 9, 2028
Laboratory DirectorStacey S. Cervantes
Laboratory Phone(386) 719-6500
Laboratory LocationMagnolia Pediatrics1140 SW Bascom Norris Rd Ste 104, Lake City, FL 32025
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

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

SAMANTHA LAWRENCE ARNP, PNP-PC
Nurse Practitioner (Pediatrics)
1140 SW BASCOM NORRIS DR STE 104
LAKE CITY, FL 32025
Columbia County (386) 719-6500
LORIELLE MANNING LANG APRN
Nurse Practitioner (Pediatrics)
1140 SW BASCOM NORRIS DR STE 104
LAKE CITY, FL 32025
Columbia County (386) 719-6500
MRS. STACEY CERVANTES ARNP
Nurse Practitioner
1140 SW BASCOM NORRIS DR STE 104
LAKE CITY, FL 32025
Columbia County (386) 719-6500
JAMILYN VAUGHN JORDAN MSN, ARNP, PNP-PC
Nurse Practitioner (Pediatrics)
1140 SW BASCOM NORRIS DR STE 104
LAKE CITY, FL 32025
Columbia County (386) 719-6500

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 Magnolia Pediatrics LLC's NPI number?

The NPI number for Magnolia Pediatrics LLC is 1356513964. It was assigned to this organization in the NPPES registry on March 24, 2008.

Where is Magnolia Pediatrics LLC located?

Magnolia Pediatrics LLC is located at 1140 SW Bascom Norris Dr Ste 104, Lake City, FL 32025. The listed phone number is (386) 719-6500.

What is Magnolia Pediatrics LLC's specialty?

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

Does Magnolia Pediatrics LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1081090) is associated with this NPI, valid through March 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Magnolia Pediatrics LLC accept?

Health plans from Ambetter Health, Ambetter of Alabama and AvMed list Magnolia Pediatrics LLC 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 Magnolia Pediatrics LLC was last updated on October 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years 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.