Carlos Jose Cebollero, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

140844 Issued in FL

Practice address

1300 Miccosukee Rd
Tallahassee, FL 32308

Phone

(850) 431-1155

Fax

(850) 431-6975

NPI assigned

Mar 14, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Carlos J Cebollero Professional name

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

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 2

Specialty

Internal Medicine

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tallahassee Memorial Healthcare IncGroup PAC ID 6103724778, 498 clinicians

Southland Hospitalist Group, LLCGroup PAC ID 8022272913, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Archbold Memorial Hospital Hospital, Thomasville, GA, CCN 110038
• Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ccebollerosantamaria21777@tallahasseememorial.direct-ci.com
• Direct secure messaging: carlos.cebollero.1@33066.direct.athenahealth.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.

• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Southland Hospitalist Group, LLC

  • Emergency Medicine Physician
  • Thomasville, GA
  • NPI 1386910586

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Monark Health Solutions

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1609692821

  Single Specialty

  Medicare reassignment NPD
• Tallahassee Memorial Healthcare Inc

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1366293102

  Single Specialty

  NPD
• Tallahassee Memorial Healthcare Inc

  • Gastroenterology Physician
  • Tallahassee, FL
  • NPI 1558983205

  Single Specialty

  NPD
• Southland Select Hospitalist Group, LLC

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1821427246

  Single Specialty

  NPD (past)
• John D Archbold Memorial Hospital Inc

  • General Acute Care Hospital
  • Thomasville, GA
  • NPI 1194779702

  Single Specialty

  NPD (past)

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

• Tallahassee Memorial Healthcare Inc

  • General Acute Care Hospital
  • Tallahassee, FL
  • NPI 1437177664
  Care Compare affiliation
• John D Archbold Memorial Hospital Inc

  • General Acute Care Hospital
  • Thomasville, GA
  • NPI 1194779702
  Care Compare affiliation
• John D. Archbold Memorial Hospital, Inc.

  • Rehabilitation Hospital Unit
  • Thomasville, GA
  • NPI 1104867738
  Care Compare affiliation

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

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1619218740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MICCOSUKEE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085054",
            "telephone_number": "850-431-1155",
            "fax_number": "850-431-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MICCOSUKEE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-431-1155",
            "fax_number": "850-431-6975"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "196-198 north st. Geneva General Hosptial",
            "address_purpose": "LOCATION",
            "city": "finger lakes",
            "state": "NY",
            "postal_code": "14456",
            "country_code": "US",
            "telephone_number": "315-787-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "372 stockholm",
            "address_2": "wyckoff heights medical center",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "11237",
            "country_code": "US",
            "telephone_number": "787-758-8383 x8494",
            "fax_number": "787-763-9758",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CEBOLLERO",
        "first_name": "CARLOS",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-14",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "293845-1",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PR",
            "license": "19186",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "140844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLOS",
            "last_name": "CEBOLLERO",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Internal Medicine Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.