Individual provider Active NPI

Jose Adenauer Castiblanco, DPM

  • Podiatrist
  • East Hartford, CT
National Provider Identifier
1356654529
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
000930 Issued in CT
Practice address
94 Connecticut Blvd
East Hartford, CT 06108-3013
Phone
(860) 528-1359
Fax
(860) 528-5180
NPI assigned
Jul 16, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 000930 CT Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 25MD00320800 NJ
Foot & Ankle Surgery Podiatrist 213ES0103X 006624 NY

Addresses

Primary practice location

94 Connecticut Blvd
East Hartford, CT 06108-3013

Mailing address

PO Box 269
Harrison, NY 10528-0269

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160114000475 CT Practitioner - Podiatry 8527361112 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rehabilitation Associates IncGroup PAC ID 8022905322, shared by 2 NPIs, 525 clinicians
Cornell Scott Hill Health CorporationGroup PAC ID 3072418359, 261 clinicians

Practice addresses (Care Compare)

1931 Black Rock Tpke
Fairfield, CT 06825-3506
Phone (203) 384-8681

428 Columbus Ave
New Haven, CT 06519-1233
Phone (203) 503-3228

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue143
Removal or shaving of skin growth34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000930CTMDAddiction (Substance Use Disorder) Counselor
25MD00320800NJMDFoot & Ankle Surgery Podiatrist
006624NYMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
First Choice Health Centers, Inc. CurrentSince Nov 4, 2015 Accepting new patients
First Choice Health Centers, Inc. CurrentSince Nov 4, 2015 Accepting new patients
Cornell Scott Hill Health Corporation CurrentSince Jul 24, 2023 Accepting new patients

Locations

94 Connecticut Blvd
Hartford, CT 06108
Phone (860) 610-6191

428 Columbus Ave
New Haven, CT 06519
Phone (203) 503-3228

410 Campbell Ave
West Haven, CT 06516
Phone (203) 503-3400

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444694400000",
    "number": "1356654529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 269",
            "city": "HARRISON",
            "state": "NY",
            "postal_code": "105280269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 CONNECTICUT BLVD",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083013",
            "telephone_number": "860-528-1359",
            "fax_number": "860-528-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTIBLANCO",
        "first_name": "JOSE",
        "middle_name": "ADENAUER",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-07-16",
        "last_updated": "2015-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CT",
            "license": "000930",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "25MD00320800",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "006624",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hartford, CT

Sources for this page

Verify at the official NPI Registry.