Individual provider Active NPI

Jennifer Eden Caballero, PA-C

  • Physician Assistant
  • Sarasota, FL
National Provider Identifier
1508142803
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 9106259 Issued in FL
Practice address
1921 Waldemere St Ste 705
Sarasota, FL 34239-2913
Phone
(941) 366-5864
NPI assigned
Oct 31, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 9106259 FL Primary

Addresses

Primary practice location

1921 Waldemere St Ste 705
Sarasota, FL 34239-2913

Mailing address

1921 Waldemere St Ste 705
Sarasota, FL 34239-2913
Phone (941) 366-5864

Other practice location 1

1700 S Tamiami Trl
Sarasota, FL 34239-3555
Phone (941) 917-9000

Other practice location 2

2600 Laurel Rd E
North Venice, FL 34275-3226
Phone (941) 917-9000

Other practice location 3

200 Healthcare Way Unit 102
North Venice, FL 34275-3670
Phone (941) 366-5864

Other identifiers 1

IdentifierTypeStateIssuer
0016967300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20111205000839 FL Practitioner - Physician Assistant 5193990042 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SMH Physician Services IncGroup PAC ID 1355240177, 781 clinicians

Practice addresses (Care Compare)

1700 S Tamiami Trail
FPG Central Billing Office
Sarasota, FL 34239-3509

1700 S Tamiami TRL
Sarasota, FL 34239-3509
Phone (941) 917-7760

1921 Waldemere St
Sarasota, FL 34239-2913

1921 Waldemere St
Sarasota, FL 34239-2941

200 Healthcare Way
North Venice, FL 34275-3670

Hospital & facility affiliations

  • Sarasota Memorial Hospital Hospital, Sarasota, FL, CCN 100087

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lung Associates of Sarasota LLC CurrentSince Dec 1, 2019 Accepting new patients
SMH Physician Services Inc Physician Assistant CurrentSince Aug 1, 2024 Accepting new patients
Angsten Center for Pulmonary & Sleep Past Accepting new patients
Jose R. Marquina, M.D., P.a. Past Accepting new patients
SMH Physician Services Inc Past Accepting new patients

Locations

200 Healthcare Way
Unit 102
North Venice, FL 34275
Phone (941) 366-5864

2600 Laurel Rd E
North Venice, FL 34275
Phone (941) 261-9000

1921 Waldemere St
Ste 705
Sarasota, FL 34239
Phone (941) 366-5864

1700 Tamiami Trl
Sarasota, FL 34239
Phone (941) 917-8507

1921 Waldemere St
Ste 307
Sarasota, FL 34239
Phone (941) 917-8565

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10086560
  • Direct secure messaging: jennifercaballero@las.allscriptsdirect.net

Organizations & group practices 6

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 1

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": "1320019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1508142803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 WALDEMERE ST STE 705",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342392913",
            "telephone_number": "941-366-5864",
            "fax_number": "941-316-9819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 WALDEMERE ST STE 705",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342392913",
            "telephone_number": "941-366-5864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 S Tamiami Trl",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342393555",
            "country_code": "US",
            "telephone_number": "941-917-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2600 Laurel Rd E",
            "address_purpose": "LOCATION",
            "city": "North Venice",
            "state": "FL",
            "postal_code": "342753226",
            "country_code": "US",
            "telephone_number": "941-917-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Healthcare Way Unit 102",
            "address_purpose": "LOCATION",
            "city": "North Venice",
            "state": "FL",
            "postal_code": "342753670",
            "country_code": "US",
            "telephone_number": "941-366-5864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CABALLERO",
        "first_name": "JENNIFER",
        "middle_name": "EDEN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-31",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9106259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016967300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sarasota, FL

Sources for this page

Verify at the official NPI Registry.