Johnny Dionisio Caraballo, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA21696 Issued in CA

Practice address

631 S Brookhurst St Ste 101
Anaheim, CA 92804-3563

Phone

(949) 297-3888

NPI assigned

Jul 20, 2011

Last updated

Feb 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Oc Urgentcare Medical Group IncorporatedGroup PAC ID 3375672835, 30 clinicians

Izuchukwu Okpara MD IncGroup PAC ID 1052698966, 45 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ADEBBD

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

• Izuchukwu Okpara MD Inc

  dba Omni Wound Physicians

  • Surgery Physician
  • Valencia, CA
  • NPI 1679004592
  Medicare reassignment Care Compare group
• Oc Urgentcare Medical Group Incorporated

  • Urgent Care Clinic/Center
  • Anaheim, CA
  • NPI 1083940597
  Medicare reassignment Care Compare group
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment Care Compare group
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Joshua Tree, CA
  • NPI 1326543745
  NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Anaheim, CA
  • NPI 1982078150
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD
• Oc Urgentcare Medical Group Incorporated

  dba Oc Urgent Care Anaheim 2

  • Urgent Care Clinic/Center
  • Anaheim, CA
  • NPI 1124692314
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Anaheim, CA
  • NPI 1952333460
  NPD
• Pacific Professional Surgical Group Inc

  • Trauma Surgery Physician
  • Riverside, CA
  • NPI 1578341608
  NPD (past)

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

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1225326549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 S BROOKHURST ST STE 101",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043563",
            "telephone_number": "949-297-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 S BROOKHURST ST STE 101",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043563",
            "telephone_number": "949-297-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARABALLO",
        "first_name": "JOHNNY",
        "middle_name": "DIONISIO",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-20",
        "last_updated": "2023-02-03",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA21696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nian Capili
• Paniz Capone
• Paul Capone
• Gordon Capp, MSW
• Enzo Caprile
• Briana Caragao, CPO
• Brianna Cardenas
• Claudia Cardenas
• Francisca Cardenas
• Juan Carlos Cardenas

• Medical Physician Assistant in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; 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.