Federico Castillo IV, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9895 Issued in IA

Practice address

3265 S 24TH St
Council Bluffs, IA 51501-6901

Phone

(712) 309-0480

Fax

(402) 934-8244

NPI assigned

Jun 29, 2015

Last updated

Jul 26, 2021By 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 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2022 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Advanced Oral Surgery, PLLC

  dba Council Bluffs Oral Surgery, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Council Bluffs, IA
  • NPI 1154970655
  NPD
• David J Rallis DDS MD Oral and Maxillofacial Surgery, PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Lincoln, NE
  • NPI 1760708218

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1437531209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3265 S 24TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515016901",
            "telephone_number": "712-309-0480",
            "fax_number": "402-934-8244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3265 S 24TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515016901",
            "telephone_number": "712-309-0480",
            "fax_number": "402-934-8244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2521 Cherry St",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641082750",
            "country_code": "US",
            "telephone_number": "325-868-0177",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2600 S 56th St Ste A",
            "address_purpose": "LOCATION",
            "city": "Lincoln",
            "state": "NE",
            "postal_code": "685063742",
            "country_code": "US",
            "telephone_number": "402-327-9400",
            "fax_number": "402-327-9401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTILLO",
        "first_name": "FEDERICO",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-29",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "9895",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2015020284",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@oralsurgerycb.com",
            "affiliation": "N",
            "endpointDescription": "Office email",
            "address_1": "3265 S 24th St",
            "city": "Council Bluffs",
            "state": "IA",
            "country_code": "US",
            "postal_code": "515016901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.