Peter Caccavallo

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

1053181A Issued in IN

Practice address

13000 E 136TH St
Suite 1100
Fishers, IN 46037-9478

Phone

(317) 678-3585

Fax

(317) 863-5084

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

Specialty

Internal Medicine

Education

Indiana University School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Indianapolis Perioperative Medicine, LLCGroup PAC ID 7618914706, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Hospital, Indianapolis, IN, CCN 150056
• Indiana University Health North Hospital Hospital, Carmel, IN, CCN 150161

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pcaccavallo@unionhealth.cernerdirect.com

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.

• Indianapolis Perioperative Medicine, LLC

  • Internal Medicine Physician
  • Fishers, IN
  • NPI 1720285976
  Medicare reassignment Care Compare group NPD Authorized official
• Indianapolis Perioperative Medicine

  • Medical Physician Assistant
  • Fishers, IN
  • NPI 1720539075
  NPD Authorized official
• Union Hospital Inc.

  • General Acute Care Hospital
  • Terre Haute, IN
  • NPI 1619975331
  NPD
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

• Indiana University Health North Hospital Inc

  • General Acute Care Hospital
  • Carmel, IN
  • NPI 1568492916
  Care Compare affiliation Name & address match
• Indiana University Health Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1144266024
  Care Compare affiliation

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405296000000",
    "number": "1205987252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13000 E 136TH ST",
            "address_2": "SUITE 1100",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379478",
            "telephone_number": "317-678-3585",
            "fax_number": "317-863-5084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 E 136TH ST",
            "address_2": "SUITE 1100",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379478",
            "telephone_number": "317-678-3585",
            "fax_number": "317-863-5084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CACCAVALLO",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2014-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "1053181A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "51-0456750",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ID NUMBER",
            "identifier": "000000287592",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200316800",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00013960",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jakob Charles Bury, PT, DPT, ATC
• David A Bussard, D.D.S., M.S.
• Carla Butorac
• Kathleen Jill Byers
• Adrianna Michelle Caballero, PHD, HSPP
• Joseph Cahoe, ED.S.
• Bethany Caine
• Jonny Calderon, RBT
• Tyler John Calton, MD
• Jasmin Calvin, LMHC

• Internal Medicine Physician in Fishers, IN
• Providers in Fishers, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.