NPIMap

Individual provider Active NPI

Jose R Carrasquillo, MD

  • Gastroenterology Physician
  • North Wilkesboro, NC
National Provider Identifier
1841387248
Registry record updated Aug 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2013-00302 Issued in NC
Practice address
1404 Willow LN
Suite B
North Wilkesboro, NC 28659-3584
Phone
(336) 903-7845
Fax
(336) 903-7841
NPI assigned
Oct 6, 2006
Last updated
Aug 1, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 2013-00302 NC Primary

Addresses

Primary practice location

1404 Willow LN
Suite B
North Wilkesboro, NC 28659-3584

Mailing address

PO Box 602658
Charlotte, NC 28260-2658
Phone (336) 716-2011

Other identifiers 1

IdentifierTypeStateIssuer
02161397MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130403000011 NC Practitioner - Gastroenterology 2860398377 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
University of Puerto Rico School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1404 Willow LN
Suite B
North Wilkesboro, NC 28659-3587
Phone (336) 903-6820

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy78
Upper gastrointestinal (GI) endoscopy for acid reflux81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2013-00302NCMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences Gastroenterology CurrentSince Jul 1, 2017 Accepting new patients
Digestive Disease Center, PA Gastroenterology CurrentSince Feb 17, 2013 Accepting new patients
Phgi Associates LTD Gastroenterology Current Accepting new patients
Goldsboro Endoscopy Center Inc CurrentSince Feb 17, 2013 Accepting new patients
Wilkes Physician Network, Inc. Current Accepting new patients

Locations

329 NC Highway 801 N
Bermuda Run, NC 27006
Phone (336) 716-8200

2705 Medical Office Pl
Goldsboro, NC 27534
Phone (919) 580-9111

1404 Willow Ln
Ste B
North Wilkesboro, NC 28659
Phone (336) 838-0735

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

230 W Washington Sq
Fl 4
Philadelphia, PA 19106
Phone (215) 829-3561

Interoperability endpoints

  • Direct secure messaging: jcarrasquillo2754633@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501545600000",
    "number": "1841387248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602658",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602658",
            "telephone_number": "336-716-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 WILLOW LN",
            "address_2": "SUITE B",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593584",
            "telephone_number": "336-903-7845",
            "fax_number": "336-903-7841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASQUILLO",
        "first_name": "JOSE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2017-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "2013-00302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02161397",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Wilkesboro, NC

Sources for this page

Verify at the official NPI Registry.