NPIMap

Individual provider Active NPI

Kevin Ceballos

  • Internal Medicine Physician
  • Georgetown, TX
National Provider Identifier
1114555190
Registry record updated Sep 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
U4166 Issued in TX
Practice address
105 Wildwood Dr Ste 105
Georgetown, TX 78633-1344
Phone
(786) 423-5819
NPI assigned
Mar 27, 2020
Last updated
Sep 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X U4166 TX Primary

Addresses

Primary practice location

105 Wildwood Dr Ste 105
Georgetown, TX 78633-1344

Mailing address

1706 Cedar Bend Dr Unit C
Austin, TX 78758-2602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230912001664 TX Practitioner - Internal Medicine 2365860160 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Area Primary Care, PLLCGroup PAC ID 9537237482, 19 clinicians

Practice addresses (Care Compare)

105 Wildwood Dr
Suite 105
Georgetown, TX 78633-1344
Phone (512) 763-4060

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
U4166TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Area Primary Care, PLLC CurrentSince Sep 1, 2023 Accepting new patients
St Davids Heart & Vascular, PLLC PastSince Sep 1, 2023 Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

105 Wildwood Dr
Ste 105
Georgetown, TX 78633
Phone (512) 763-4060

3201 S Austin Ave
Ste 210
Georgetown, TX 78626
Phone (512) 763-4000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/3648/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kevin.ceballos@hca8.eclinicaldirectplus.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1114555190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 CEDAR BEND DR UNIT C",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787582602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WILDWOOD DR STE 105",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786331344",
            "telephone_number": "786-423-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEBALLOS",
        "first_name": "KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "U4166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

Verify at the official NPI Registry.