Individual provider Active NPI

Juan Carlos La Rosa Pedroso, PAC

  • Physician Assistant
  • Miami, FL
National Provider Identifier
1700168176
Registry record updated Dec 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10789 Issued in TX
Practice address
15523 SW 71St St
Miami, FL 33193-2104
Phone
(971) 227-4063
Fax
(971) 227-4063
NPI assigned
Sep 12, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2016

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 PA10789 TX Primary

Addresses

Primary practice location

15523 SW 71St St
Miami, FL 33193-2104

Mailing address

15523 SW 71St St
Miami, FL 33193-2104
Phone (971) 227-4063

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170110001135 TX Practitioner - Physician Assistant 5395026140 Reassigns benefits to 4 organizations
I20200416003965 FL Practitioner - Physician Assistant 5395026140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
74.27
Improvement activities
40
Cost
78.06

Merit-based Incentive Payment System (MIPS)

Final score
96.38 of 100Reported as group
Quality
80.82
Promoting interoperability
91
Improvement activities
40
Cost
84.44

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jul 11, 2022 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Aug 1, 2024 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Aug 1, 2024 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jul 11, 2022 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Apr 15, 2020 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Apr 15, 2020 Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Baylor College of Medicine CurrentSince Nov 28, 2016 Accepting new patients
Baylor College of Medicine CurrentSince Nov 28, 2016 Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1504 Taub Loop
Houston, TX 77030
Phone (713) 873-2860

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1700168176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15523 SW 71ST ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331932104",
            "telephone_number": "971-227-4063",
            "fax_number": "971-227-4063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15523 SW 71ST ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331932104",
            "telephone_number": "971-227-4063",
            "fax_number": "971-227-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA ROSA PEDROSO",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-12",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.