Individual provider Active NPI

Israel Eduardo Carrasquillo - Cruz, APRN

  • Acute Care Nurse Practitioner
  • Sarasota, FL
National Provider Identifier
1669003174
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
11005651 Issued in FL
Practice address
1700 S Tamiami TRL
Sarasota, FL 34239-3509
Phone
(941) 917-4896
Fax
(941) 917-6884
NPI assigned
Feb 3, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 11005651 FL Primary

Addresses

Primary practice location

1700 S Tamiami TRL
Sarasota, FL 34239-3509

Mailing address

PO Box 863407
Orlando, FL 32886-3407
Phone (941) 917-2600

Other identifiers 1

IdentifierTypeStateIssuer
11005651OtherFLAPRN LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL yunyo55@gmail.com Health Information Exchange (HIE)

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
I20210921002819 FL Practitioner - Nurse Practitioner 1759788540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
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 TRL
Sarasota, FL 34239-3509
Phone (941) 917-7760

Hospital & facility affiliations

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11005651FLMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SMH Physician Services Inc CurrentSince Sep 20, 2021 Accepting new patients
SMH Physician Services Inc Past Accepting new patients

Locations

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

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

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 2

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": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1669003174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 863407",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328863407",
            "telephone_number": "941-917-2600",
            "fax_number": "941-917-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S TAMIAMI TRL",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342393509",
            "telephone_number": "941-917-4896",
            "fax_number": "941-917-6884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASQUILLO - CRUZ",
        "first_name": "ISRAEL",
        "middle_name": "EDUARDO",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-03",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11005651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSE",
            "identifier": "11005651",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "yunyo55@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Right now for purpose of filling application",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4513 Coker Rd",
            "city": "North Port",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342866021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sarasota, FL

Sources for this page

Verify at the official NPI Registry.