Blake Ernesto Carrillo, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9107380 Issued in FL

Practice address

14150 SW 136TH St
Miami, FL 33186-5506

Phone

(786) 204-4600

NPI assigned

Sep 2, 2013

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: blake.carrillopac.p1@direct.thespinecenter.nextgenshare.com

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.

• Emergent Physicians of Palmetto Bay, LLC

  • Emergency Medicine Physician
  • Palmetto Bay, FL
  • NPI 1639991912
  Medicare reassignment NPD
• E-Med LLP

  • Emergency Medical Services (Emergency Medicine) Physician
  • Boca Raton, FL
  • NPI 1043206212
  Medicare reassignment
• Emergent Physicians of Country Walk, LLC

  • Emergency Medicine Physician
  • Miami, FL
  • NPI 1114497005
  Medicare reassignment
• Emergent Physicians of Doral, LLC

  • Emergency Medicine Physician
  • Miami, FL
  • NPI 1245909449
  Medicare reassignment
• Emergent Physicians of Miami Lakes, LLC

  • Emergency Medicine Physician
  • Miami Lakes, FL
  • NPI 1730901018
  Medicare reassignment
• Emergent Physicians of West Dade, LLC

  • Emergency Medicine Physician
  • Miami, FL
  • NPI 1275200537
  Medicare reassignment
• Small Hospital Innovations LLC

  • Emergency Medicine Physician
  • Clewiston, FL
  • NPI 1184040560
  Medicare reassignment

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

{
    "created_epoch": "1378080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1588098040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 KINGS WAY",
            "city": "ROYAL PALM BEACH",
            "state": "FL",
            "postal_code": "334111568",
            "telephone_number": "786-316-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14150 SW 136TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865506",
            "telephone_number": "786-204-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14100 SW 136th St",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331865506",
            "country_code": "US",
            "telephone_number": "786-204-4600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "BLAKE",
        "middle_name": "ERNESTO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-02",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9107380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jorge Luis Carrillo Moya, HSE
• Miladys Carrillo Paulke
• Yasmary Carrillo Ravelo, RBT
• Alexander Carrillo, DPT
• Barbara Carrillo, LCSW
• Carlos Carrillo
• Catalina Pardo Carrillo, DDS
• Claudia Carrillo
• Cristina Carrillo
• Eleanor Torres Carrillo, P.T.

• Medical Physician Assistant in Miami, FL
• Providers in Miami, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; 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.