Melissa Richardson Caraballo, D.O.
Individual provider Active NPI Pediatrics Physician · Marianna, FL
NPI 1750677282 · NPPES record last updated Mar 3, 2021
Key facts
- NPI
- 1750677282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- OS 12572 (FL)
- Practice address
- 3028 4TH St Ste a&B
Marianna, FL 32446-2127 - Phone
- (850) 718-2886
- Fax
- (850) 633-5908
- NPI assigned
- Jun 23, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160922002758 | FL | Order and Referring Only - Pediatric Medicine |
4284921941 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS 12572 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| ER Physician Group at Jackson Hospital | Past |
Accepting new patients |
Interoperability endpoints
- melissacaraballo@jh.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | OS 12572 | FL | Yes |
Addresses
Primary practice location
3028 4TH St Ste a&B
Marianna, FL 32446-2127
Mailing address
4250 Hospital Dr
Marianna, FL 32446-1917
Phone (850) 718-2886
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012137600 | Medicaid | FL |
Other names
- Miss Melissa Richardson Milito
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All providers in Marianna, FL · Pediatrics Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.