NPIMap

Individual provider Active NPI

Pearl Carrillo, DO

  • Family Medicine Physician
  • Marshall, MO
National Provider Identifier
1487602991
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2007001548 Issued in MO
Practice address
2305 S Highway 65 BLDG a
Marshall, MO 65340-3702
Phone
(660) 886-7800
Fax
(660) 831-3306
NPI assigned
May 5, 2006
Last updated
Mar 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2007001548 MO Primary
Hospitalist Physician 208M00000X 2007001548 MO

Addresses

Primary practice location

2305 S Highway 65 BLDG a
Marshall, MO 65340-3702

Mailing address

2305 South 65 Highway
P O Box 158
Marshall, MO 65340-3702
Phone (660) 886-7431

Other practice location 1

2305 South 65 Highway
Marshall, MO 65340-3702
Phone (660) 886-7431

Other identifiers 5

IdentifierTypeStateIssuer
7713239OtherMOAETNA PIN
38337016OtherMOBLUE CROSS BLUE SHIELD OF KC
205472509MedicaidMO
795915OtherMOHEALTHLINK PIN
H43884OtherMOMERCY HEALTH PLANS PIN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address PEARLCARRILLO@fitzgibbon.cernerdirect.com Direct
Direct Messaging Address PEARLCARRILLO@fitzgibbon.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070702000398 MO Practitioner - Family PracticePractitioner - Emergency Medicine 9133229222 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
University of North Texas HSC, College of Osteopathic Med, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2305 S Hwy 65
Marshall, MO 65340-3702
Phone (660) 886-7800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
John Fitzgibbon Memorial Hospital Inc Current Accepting new patients
John Fitzgibbon Memorial Hospital Inc CurrentSince Jul 1, 2010 Accepting new patients
John Fitzgibbon Memorial Hospital, Inc. Current Accepting new patients
John Fitzgibbon Memorial Hospital Inc. CurrentSince Jul 1, 2010 Accepting new patients
Shepherd Mountain Emergency Physicians Past Accepting new patients

Locations

815 E Broadway St
Brunswick, MO 65236
Phone (660) 548-3161

600 W Morrison St
Fayette, MO 65248
Phone (660) 248-2900

2303 S Highway 65
Ste A
Marshall, MO 65340
Phone (660) 831-1175

2305 S Highway 65
Marshall, MO 65340
Phone (660) 831-3730

2305 S Highway 65
Bldg A
Marshall, MO 65340
Phone (660) 886-7800

212 College St
Pilot Grove, MO 65276
Phone (660) 831-3728

420 W Front St
Slater, MO 65349
Phone (660) 529-2251

Interoperability endpoints

  • Direct secure messaging: pearlcarrillo@fitzgibbon.cernerdirect.com

Organizations & group practices 5

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1487602991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 SOUTH 65 HIGHWAY",
            "address_2": "P O BOX 158",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7431",
            "fax_number": "660-886-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 S HIGHWAY 65 BLDG A",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7800",
            "fax_number": "660-831-3306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2305 South 65 Highway",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "MO",
            "postal_code": "653403702",
            "country_code": "US",
            "telephone_number": "660-886-7431",
            "fax_number": "660-831-3335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "PEARL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2007001548",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2007001548",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "7713239",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF KC",
            "identifier": "38337016",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205472509",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK PIN",
            "identifier": "795915",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY HEALTH PLANS PIN",
            "identifier": "H43884",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PEARLCARRILLO@fitzgibbon.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Pearl Carrillo John Fitzgibbon Memorial Hospital DIRECT Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "2305 South 65 Highway",
            "city": "Marshall",
            "state": "MO",
            "country_code": "US",
            "postal_code": "653403702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PEARLCARRILLO@fitzgibbon.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Pearl Carrillo John Fitzgibbon Memorial Hospital Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2305 S Highway 65 Bldg A",
            "city": "Marshall",
            "state": "MO",
            "country_code": "US",
            "postal_code": "653403702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marshall, MO

Sources for this page

Verify at the official NPI Registry.