Individual provider Active NPI

Damian E Caraballo IV, MD

  • Emergency Medicine Physician
  • Tampa, FL
National Provider Identifier
1801007166
Registry record updated Aug 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME106340 Issued in FL
Practice address
3001 W MLK Blvd
Tampa, FL 33607-6387
Phone
(813) 870-4000
NPI assigned
May 25, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X ME106340 FL Primary

Addresses

Primary practice location

3001 W MLK Blvd
Tampa, FL 33607-6387

Mailing address

2502 W Saint Isabel St
Tampa, FL 33607-6318
Phone (813) 874-5707

Other practice location 1

3100 E Fletcher Ave
Tampa, FL 33613-4613
Phone (813) 971-6000

Other identifiers 2

IdentifierTypeStateIssuer
002475100MedicaidFL
148U3OtherFLBCBS FLORIDA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100818000238 FL Practitioner - Emergency Medicine 3173676244 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Florida College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Medical Associates of Tampa Bay LLCGroup PAC ID 3678746674, 84 clinicians

Practice addresses (Care Compare)

3001 W Dr Martin Luther King Jr Blvd
Tampa, FL 33607-6307
Phone (813) 870-4000

Hospital & facility affiliations

  • St Josephs Hospital Hospital, Tampa, FL, CCN 100075

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME106340FLMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Observation Medical Group LLC Emergency Medicine CurrentSince Feb 5, 2019 Accepting new patients
Observation Medical Group LLC Emergency Medicine CurrentSince Feb 5, 2019 Accepting new patients
Emergency Medical Associates of Tampa Bay, LLC Emergency Medicine CurrentSince Feb 5, 2019 Accepting new patients
Neuse River Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

4211 Van Dyke Rd
Lutz, FL 33558
Phone (813) 265-6300

6901 Simmons Loop
Riverview, FL 33578
Phone (813) 302-8000

2502 W Saint Isabel St
Tampa, FL 33607
Phone (813) 874-5707

3001 W Mlk Blvd
Tampa, FL 33607
Phone (813) 361-6778

4501 Bruce B Downs Blvd
Wesley Chapel, FL 33544
Phone (813) 870-4000

Organizations & group practices 4

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 2

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": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1801007166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 W SAINT ISABEL ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076318",
            "telephone_number": "813-874-5707",
            "fax_number": "813-874-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W MLK BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076387",
            "telephone_number": "813-870-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 E Fletcher Ave",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336134613",
            "country_code": "US",
            "telephone_number": "813-971-6000",
            "fax_number": "813-972-5753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARABALLO",
        "first_name": "DAMIAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME106340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002475100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "148U3",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.