Roman Criollo, M.D

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME137455 Issued in FL

Practice address

1680 Dunn Ave
Jacksonville, FL 32218-4782

Phone

(904) 760-4904

NPI assigned

Dec 7, 2006

Last updated

Nov 11, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14502/brand/1/csg/1/fhir/r4
• Direct secure messaging: ronan.criollo.1@12891.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Agape Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
  • NPI 1962867762
  Medicare reassignment NPD
• Agape Community Health Center, Inc

  dba Agape Community Health Center, Inc- University

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
  • NPI 1245695774
  NPD
• Agape Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
  • NPI 1326668351
  NPD (past)
• Agape Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
  • NPI 1376178814
  NPD (past)
• Agape Community Health Center, Inc.

  dba Wesconnett Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
  • NPI 1578928826
  NPD (past)
• Spectrum Health Center, P.C.

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1215972104

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699660800000",
    "number": "1699834408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 DUNN AVE UNIT 35-37",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184782",
            "telephone_number": "904-760-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184782",
            "telephone_number": "904-760-4904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 King St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322042410",
            "country_code": "US",
            "telephone_number": "904-760-4904",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5460 Blanding Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322441957",
            "country_code": "US",
            "telephone_number": "904-760-4904",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10365 Hood Rd S Ste 204",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322573261",
            "country_code": "US",
            "telephone_number": "904-738-7045",
            "fax_number": "904-738-7678",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRIOLLO",
        "first_name": "ROMAN",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-07",
        "last_updated": "2023-11-11",
        "certification_date": "2023-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "38184",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME137455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118398900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101870300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffery Crick, DO
• John C Crick, M.D.
• Samantha Brooke Crickmore, LM, CPM
• Mary Ellen Crilley, M. ED.
• Frank Crimi, LPN
• Lori C Crisafulli, M.ED
• Larry Van Thomas Crisco, MD
• Crisis & Christian Counseling, Inc
• Crisis Recovery and Progressive Path Services Inc.
• Amy Crismon

• Pediatrics Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2023; 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.