Individual provider Active NPI

Pedro R Hernandez Acosta, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Madison, WI
National Provider Identifier
1184015612
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
67463-20 Issued in WI
Practice address
700 S Park St
Madison, WI 53715-1830
Phone
(608) 251-6100
NPI assigned
Feb 5, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 67463-20 WI Primary

Addresses

Primary practice location

700 S Park St
Madison, WI 53715-1830

Mailing address

700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100

Other practice location 1

700 S Park St
Madison, WI 53715-1830
Phone (608) 251-6100

Other identifiers 1

IdentifierTypeStateIssuer
1184015612MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address phernandezacosta258827@direct-ehr-ssmhc.com Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20170815003266 WI Practitioner - Critical Care (Intensivists) 6002188794 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67463-20WIMDCritical Care Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dean Health Systems, Inc CurrentSince Jul 26, 2017 Accepting new patients
Dean Health Systems, Inc. CurrentSince Jul 26, 2017 Accepting new patients

Locations

1808 W Beltline Hwy
Madison, WI 53713
Phone (608) 250-1497

700 S Park St
Madison, WI 53715
Phone (608) 260-2900

515 22nd Ave
Monroe, WI 53566
Phone (608) 324-1000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1423094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606089600000",
    "number": "1184015612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151830",
            "telephone_number": "608-251-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S PARK ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537151830",
            "telephone_number": "608-251-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 S Park St",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537151830",
            "country_code": "US",
            "telephone_number": "608-251-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ ACOSTA",
        "first_name": "PEDRO",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-05",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WI",
            "license": "67463-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184015612",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "phernandezacosta258827@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "phernandezacosta258827@direct-ehr-ssmhc.com",
            "address_1": "700 S Park St",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "700 S Park St",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.