LAKE PEDIATRICS P. A.
NPI 1942367370
Clinic/Center - Rural Health in Mount Dora, FL
About Lake Pediatrics P. A. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE PEDIATRICS P. A. (NPI 1942367370), doing business as Lake Pediatrics, P.a., is a healthcare organization registered as a rural health in Mount Dora, Florida and active in the NPI registry since January 2007. The organization lists Donna Lynn Nettles, Billing Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Lake Pediatrics P. A. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Lake Pediatrics P. A., which bills Medicare for the services they deliver. Of these, 2 practice at this address. 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.
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 Lake Pediatrics P. A.'s NPI number?
The NPI number for Lake Pediatrics P. A. is 1942367370. It was assigned to this organization in the NPPES registry on January 3, 2007. The provider is doing business as Lake Pediatrics, P.A..
Where is Lake Pediatrics P. A. located?
Lake Pediatrics P. A. is located at 4880 N Highway 19A Ste 200, Mount Dora, FL 32757. The listed phone number is (352) 589-8111.
What is Lake Pediatrics P. A.'s specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Lake Pediatrics P. A. enrolled in Medicare?
Yes. Lake Pediatrics P. A. is registered in the Medicare PECOS enrollment system.
When is Lake Pediatrics P. A.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (Florida, Rural Health Clinic) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Lake Pediatrics P. A.?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Lake Pediatrics P. A., in Nurse Practitioner and Pediatric Medicine. 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. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Lake Pediatrics 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 UnitedHealthcare and 1 other insurer list Lake Pediatrics 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 Lake Pediatrics P. A. was last updated on November 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Lake Pediatrics P. A. · NPI 1942367370
Rural Health organization in Mount Dora, Florida. Organization record, active in the CMS NPPES registry since January 3, 2007.
## Identity
- **NPI:** 1942367370 (Entity type: Organization)
- **Enumerated:** January 3, 2007
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Also known as:** Lake Pediatrics, P.A. (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Donna Nettles, BILLING MANAGER
## Practice location
- **Address:** 4880 N HIGHWAY 19A STE 200, Mount Dora, FL 32757-2018
- **Phone:** (352) 589-8111 · **Fax:** (352) 589-8111
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Part A, Florida, Rural Health Clinic) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (1), Pediatric Medicine (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 12, 2025
- **Other identifiers:** Medicaid 126977000 (FL)
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Source: [NPI Profile](https://npiprofile.com/npi/1942367370) · Data from the CMS NPPES public registry.