Rodolfo Bartolome Carrillo Sr., MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

033243 Issued in GA

Practice address

420 Broad St SE
Gainesville, GA 30501-3726

Phone

(770) 536-8885

Fax

(770) 536-8725

NPI assigned

Oct 16, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376633586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 BROAD ST SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "30501",
            "telephone_number": "770-536-8885",
            "fax_number": "770-536-8725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 BROAD ST SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013726",
            "telephone_number": "770-536-8885",
            "fax_number": "770-536-8725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "RODOLFO",
        "middle_name": "BARTOLOME",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "033243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0TH000",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Kate Carman, ATC
• Anna M Carmichael, CCC-SLP
• Laura E Carmichael, CRNA
• Tatum L Carpenter
• Jeniffer Carol Culbertson Carpinello, NP
• Amanda Elizabeth Carroll, PA
• Michael Carroll, M.D.
• Gennie Lynn Carter, DC
• Jerry Carter III
• Patricia Lorraine Carter, L.P.C.

• General Practice Physician in Gainesville, GA
• Providers in Gainesville, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.