Individual provider Active NPI

Juan C. Acosta Caraballo, MD

  • Neonatal-Perinatal Medicine Physician
  • Boca Raton, FL
National Provider Identifier
1154580561
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
156515 Issued in FL
Practice address
800 Meadows Rd
Boca Raton, FL 33486-2304
Phone
(561) 955-7100
NPI assigned
Jun 2, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 01062159A IN
Neonatal-Perinatal Medicine Physician 2080N0001X 156515 FL Primary

Addresses

Primary practice location

800 Meadows Rd
Boca Raton, FL 33486-2304

Mailing address

1301 Concord Ter
Sunrise, FL 33323-2843
Phone (800) 243-3839

Other identifiers 4

IdentifierTypeStateIssuer
7100262590MedicaidKY
200937500MedicaidIN
000000961789OtherINANTHEM PROVIDER NUMBER
3072124MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jacosta1@direct.iuhealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130621000326 IN Practitioner - Pediatric Medicine 3971742081 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
156515FLMDNeonatal-Perinatal Medicine Physician
01062159AINMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arnett Clinic, LLC CurrentSince Nov 1, 2015 Accepting new patients
Arnett Clinic, LLC Current Accepting new patients
Indiana University Health Southern Indiana Physicians, LLC CurrentSince Dec 5, 2021 Accepting new patients
Arnett Clinic, LLC CurrentSince Nov 1, 2015 Accepting new patients
Indiana University Health Southern Indiana Physicians LLC CurrentSince Dec 5, 2021 Accepting new patients

Locations

8016 Reliable Pkwy
Chicago, IL 60686

601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252

727 W 2nd St
Bloomington, IN 47403
Phone (812) 353-3450

2651 E Discovery Pkwy
Bloomington, IN 47408
Phone (812) 353-9147

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779

2600 Ferry St
Lafayette, IN 47904

2600 Greenbush St
Lafayette, IN 47904

Interoperability endpoints

  • Direct secure messaging: jacosta1@direct.iuhealth.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1154580561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 CONCORD TER",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232843",
            "telephone_number": "800-243-3839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MEADOWS RD",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334862304",
            "telephone_number": "561-955-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACOSTA CARABALLO",
        "first_name": "JUAN",
        "middle_name": "C.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-02",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IN",
            "license": "01062159A",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "FL",
            "license": "156515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100262590",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200937500",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000961789",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3072124",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jacosta1@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "601 W 2nd St",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474032317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

Verify at the official NPI Registry.