Active NPI
Juan C. Acosta Caraballo, MD
- Neonatal-Perinatal Medicine Physician
- Boca Raton, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neonatal-Perinatal Medicine Physician
- License
- 156515
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100262590 | Medicaid | KY | |
| 200937500 | Medicaid | IN | |
| 000000961789 | Other | IN | ANTHEM PROVIDER NUMBER |
| 3072124 | Medicaid | OH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 156515 | FL | MD | Neonatal-Perinatal Medicine Physician |
| 01062159A | IN | MD | Neonatal-Perinatal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arnett Clinic, LLC | Current | Accepting new patients | |
| Arnett Clinic, LLC | Current | Accepting new patients | |
| Indiana University Health Southern Indiana Physicians, LLC | Current | Accepting new patients | |
| Arnett Clinic, LLC | Current | Accepting new patients | |
| Indiana University Health Southern Indiana Physicians LLC | Current | 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
- 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.
-
- Multi-Specialty Clinic/Center
- Bloomington, IN
- NPI 1013953983
IN
-
- Durable Medical Equipment & Medical Supplies
- Lafayette, IN
- NPI 1699839563
-
- Clinical Medical Laboratory
- Lafayette, IN
- NPI 1881655090
-
- Durable Medical Equipment & Medical Supplies
- Bloomington, IN
- NPI 1063179844
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.