Jimmy Rafael Carrillo, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9106175 Issued in FL

Practice address

3269 Highway 90
Bonifay, FL 32425-6001

Phone

(850) 547-9991

Fax

(850) 547-9992

NPI assigned

Oct 27, 2011

Last updated

Oct 27, 2011By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in FL, AL2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holmes County Hospital CorpGroup PAC ID 3375557887, 21 clinicians

Rmcca Clinic B, LLCGroup PAC ID 3072957406, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Doctors Memorial Hospital Hospital, Bonifay, FL, CCN 101307
• The Health Care Authority of the City of Greenville- LV Stabler Hospital Hospital, Greenville, AL, CCN 010150

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1605/brand/1/csg/26/fhir/r4

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.

• Rmcca Clinic B, LLC

  dba Regional Medical Center Providers

  • Hospitalist Physician
  • Greenville, AL
  • NPI 1275184848
  Medicare reassignment Care Compare group NPD
• Holmes County Hospital Corp

  dba Doctors Memorial Hospital

  • Critical Access Hospital
  • Bonifay, FL
  • NPI 1366431702
  Medicare reassignment Care Compare group
• FL-I Medical Services, LLC

  • Nurse Practitioner
  • Fort Pierce, FL
  • NPI 1750655106
  Medicare reassignment
• Leonel P Welch Basulto, MD

  • Family Medicine Physician
  • Bonifay, FL
  • NPI 1316970262
  Medicare reassignment
• FL-I Medical Services LLC

  • Emergency Medicine Physician
  • Destin, FL
  • NPI 1659720654
  NPD
• Holmes County Hospital Corp

  dba Bonifay Rural Health Clinic

  • Rural Health Clinic/Center
  • Bonifay, FL
  • NPI 1952917015
  NPD
• The Pathology Group of Northwest Florida PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Pensacola, FL
  • NPI 1114153269
  NPD
• Vivid Pathology PA

  • Anatomic Pathology & Clinical Pathology Physician
  • Pensacola, FL
  • NPI 1760738611
  NPD
• Stabler Clinic, P.C.

  • Pediatrics Physician
  • Greenville, AL
  • NPI 1730181819
  NPD (past)

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

• Holmes County Hospital Corp

  dba Doctors Memorial Hospital

  • Critical Access Hospital
  • Bonifay, FL
  • NPI 1366431702
  Care Compare affiliation
• The Health Care Authority of the City of Greenville - LV Stabler Hospi

  dba LV Stabler Memorial Hospital

  • General Acute Care Hospital
  • Greenville, AL
  • NPI 1780655332
  Care Compare affiliation

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

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1285910778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3269 HIGHWAY 90",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "324256001",
            "telephone_number": "850-547-9991",
            "fax_number": "850-547-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3269 HIGHWAY 90",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "324256001",
            "telephone_number": "850-547-9991",
            "fax_number": "850-547-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "JIMMY",
        "middle_name": "RAFAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-27",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonifay NSG & Rehab
• Bonifay Physical Therapy
• Boswell Manor LLC
• James Forrest Bowen, D.M.D.
• Railyn Kyse Bowers
• Hallie Carroll
• CB Health Ventures, Inc. (Dogwood Inn)
• Sarah E Chapman
• Charles Christian
• Clifford L. Wood O.D. P.a.

• Medical Physician Assistant in Bonifay, FL
• Providers in Bonifay, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; 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.