Carlos Eugenio Chavez de Paz Villanueva, M.D.

Key facts

NPI

1770622011

Entity type

Individual (NPI type 1)

Primary specialty

Surgery Physician 208600000X

License

MD22709 (ME)

Practice address

163 Van Buren Rd
Caribou, ME 04736

Phone

(207) 498-3111

NPI assigned

Feb 5, 2007

Sex

Male

Sole proprietor

No

Organizations & group practices 11

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.

• Tidalhealth Physician Network, Inc. Family Medicine Physician · Seaford, DE · NPI 1467534636
  Medicare reassignment Care Compare group NPD DE
• Tidalhealth Specialty Care, LLC Medical Specialty Clinic/Center · Salisbury, MD · NPI 1619504735
  Medicare reassignment Care Compare group NPD MD
• Pines Health Services Internal Medicine Physician · Caribou, ME · NPI 1942277819
  Medicare reassignment NPD ME · SURGERY
• Tidalhealth Specialty Care, LLC Orthopaedic Surgery Physician · Lewes, DE · NPI 1134077845
  Care Compare group
• Tidalhealth Specialty Care, LLC Orthopaedic Surgery Physician · Seaford, DE · NPI 1164370854
  Care Compare group
• Tidalhealth Specialty Care, LLC Orthopaedic Surgery Physician · Ocean Pines, MD · NPI 1225986003
  Care Compare group
• Tidalhealth Specialty Care, LLC Orthopaedic Surgery Physician · Millsboro, DE · NPI 1477497725
  Care Compare group
• Tidalhealth Specialty Care, LLC Orthopaedic Surgery Physician · Salisbury, MD · NPI 1881542678
  Care Compare group
• Tidalhealth Specialty Care, LLC Orthopaedic Surgery Physician · Millsboro, DE · NPI 1902754609
  Care Compare group
• Pines Health Services Federally Qualified Health Center (FQHC) · Washburn, ME · NPI 1922449834
  NPD
• Tidalhealth Specialty Care, LLC Adult Mental Health Clinic/Center · Salisbury, MD · NPI 1962027094
  NPD (past)

Hospital & facility affiliations 2

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

• Peninsula Home Care at Nanticoke LLC Home Health Agency · Laurel, DE · NPI 1780664953
  Care Compare affiliation Home health agency
• Tidalhealth Nanticoke, Inc General Acute Care Hospital · Seaford, DE · NPI 1245214477
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

General Surgery

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tidalhealth Physician Network, Inc. (115 clinicians)
Tidalhealth Specialty Care LLC (375 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tidalhealth Home Care Home health agency · Laurel, DE · CCN 087036
• Tidalhealth Nanticoke, Inc. Hospital · Seaford, DE · CCN 080006

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled (3 enrollments) in ME, DE, MD

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 27, 2020.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580083200000",
    "number": "1770622011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 480",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "047360480",
            "telephone_number": "909-252-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 VAN BUREN RD",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "04736",
            "telephone_number": "207-498-3111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11234 Anderson St",
            "address_2": "General Surgery Department",
            "address_purpose": "LOCATION",
            "city": "Loma Linda",
            "state": "CA",
            "postal_code": "923542804",
            "country_code": "US",
            "telephone_number": "909-558-4289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAVEZ DE PAZ VILLANUEVA",
        "first_name": "CARLOS",
        "middle_name": "EUGENIO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ME",
            "license": "MD22709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Caribou, ME · Surgery Physician in Maine