Daniel Carballo, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

59095 Issued in MN

Practice address

3955 Parklawn Ave Ste 120
Edina, MN 55435-5660

Phone

(952) 278-6950

Fax

(952) 278-6947

NPI assigned

May 22, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/1846cf9e-8006-4277-b72f-3cbbe8a8f5ca/

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

• Southdale Pediatric Associates, LTD

  • Multi-Specialty Clinic/Center
  • Edina, MN
  • NPI 1245305895
  NPD (past)

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1144580242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 PARKLAWN AVE STE 120",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355660",
            "telephone_number": "952-278-6950",
            "fax_number": "952-278-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3955 PARKLAWN AVE STE 120",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355660",
            "telephone_number": "952-278-6950",
            "fax_number": "952-278-6947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBALLO",
        "first_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-22",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "59095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dustin Patrick Campion, D.C.
• Suzanne Kathryn Canney Nguyen, PA-C
• Herbert L Cantrill, MD
• John Capen, MD
• Capernaum Pediatric Therapy, Inc.
• Cardinal Family Chiropractic, LTD.
• Cardiovascular Imaging Consultants, LLC
• Carextra Home Health, LLC
• Blake A Carlson, MD
• Carol M Carlson, MD

• Pediatrics Physician in Edina, MN
• Providers in Edina, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.