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PARK AVENUE PEDIATRICS PA
NPI 1417914797
Pediatrics in Roanoke Rapids, NC

Active since April 28, 2006CLIA 34D0720954 · Waiver
529 BECKER DR, ROANOKE RAPIDS, NC 27870(252) 537-6465(252) 535-0951 Get Directions Write a Review

NPPES record last updated: February 15, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 15, 2022, Mar 21, 2016 (2 updates tracked since 2016).

About Park Avenue Pediatrics Pa NPPES

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

PARK AVENUE PEDIATRICS PA (NPI 1417914797) is a healthcare organization registered as a pediatrics in Roanoke Rapids, North Carolina and active in the NPI registry since April 2006. The organization holds a CLIA Waiver certificate valid through March 31, 2028 and lists Sandeep Kumar Tiwari, President, as its authorized official.

NPPES Registry Identity

NPI1417914797
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NamePARK AVENUE PEDIATRICS PA
Location Address529 BECKER DRRoanoke Rapids, NC 27870-3303
Mailing Address529 Becker DrRoanoke Rapids, NC 27870-3303 · (252) 537-6465 · Fax (252) 535-0951
Phone(252) 537-6465
Fax(252) 535-0951
Organization SubpartNo
Authorized OfficialSandeep Kumar TiwariPresident · (252) 537-6465
Enumeration DateApril 28, 2006
Last NPPES UpdateFebruary 15, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 15, 2022
✔ NPI 1417914797 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in NC · 38443
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.
529 BECKER DR, Roanoke Rapids, NC 27870
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Other Identifiers 4

Other139315VA · Bc Va
Medicaid006701019VA
Medicaid8915527NC
Other15527NC · Bc Nc

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 Cigna Healthcare.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)

Park Avenue Pediatrics Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Park Avenue Pediatrics PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Sandeep Tiwari, MD
Pediatric Medicine
NPI 1669450458
529 BECKER DR
Roanoke Rapids, NC 27870
(252) 537-6465
✔ PECOSSame address

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 34D0720954

Park Avenue Pediatrics, PA · Roanoke Rapids, NC
Active · expires Mar 31, 2028
CLIA Number34D0720954
Laboratory TypePhysician Office
Certificate Effective DateApril 1, 2026
Certificate Expiration DateMarch 31, 2028
Laboratory DirectorSandeep K. Tiwari
Laboratory Phone(252) 537-6465
Laboratory LocationPark Avenue Pediatrics, PA529 Becker Drive, Roanoke Rapids, NC 27870
CLIA data matches this NPI record on: Address 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 Park Avenue Pediatrics PA's NPI number?

The NPI number for Park Avenue Pediatrics PA is 1417914797. It was assigned to this organization in the NPPES registry on April 28, 2006.

Where is Park Avenue Pediatrics PA located?

Park Avenue Pediatrics PA is located at 529 Becker Dr, Roanoke Rapids, NC 27870. The listed phone number is (252) 537-6465.

What is Park Avenue Pediatrics PA's specialty?

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

Is Park Avenue Pediatrics PA enrolled in Medicare?

Yes. Park Avenue Pediatrics PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Park Avenue Pediatrics PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Pediatric Medicine) reassigns their Medicare billing to Park Avenue Pediatrics PA. 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 Park Avenue Pediatrics PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D0720954) is associated with this NPI, valid through March 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Park Avenue Pediatrics PA accept?

Health plans from Cigna Healthcare list Park Avenue Pediatrics PA 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 Park Avenue Pediatrics PA was last updated on February 15, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.