Edgar Ricardo Carrillo, MPAS, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10432 Issued in TX

Practice address

640 S Expressway 77 Ste 2
Raymondville, TX 78580-4241

Phone

(956) 689-4120

Fax

(956) 689-4142

NPI assigned

Apr 22, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Optimum Pediatrics PLLC

  • Pediatrics Physician
  • Mission, TX
  • NPI 1205664828
  NPD

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

{
    "created_epoch": "1461283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461283200000",
    "number": "1891149142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2813 W FERN AVE",
            "city": "MCALLEN",
            "state": "TX",
            "postal_code": "785016237",
            "telephone_number": "956-212-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 S EXPRESSWAY 77 STE 2",
            "city": "RAYMONDVILLE",
            "state": "TX",
            "postal_code": "785804241",
            "telephone_number": "956-689-4120",
            "fax_number": "956-689-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "EDGAR",
        "middle_name": "RICARDO",
        "name_prefix": "Mr.",
        "credential": "MPAS, PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-22",
        "last_updated": "2016-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA10432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniella Maritza Cantu
• George Cantu, MD
• Marissa Betancourt Cantu, SLP-A
• Roxanne Marie Cantu, SLP-A
• Kristen Marie Carranco, MSN, APRN, FNP-C
• Reynaldo Chavez Jr., PTA
• Children First Pediatric Rehabilitation, LLP
• Churchill Dialysis LLC
• Raquel Closner, M.S., CCC-SLP
• Kimberly Anne Collins, PA

• Medical Physician Assistant in Raymondville, TX
• Providers in Raymondville, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.