NPIMap

Individual provider Active NPI

Jorge Luis Castaneda, M.D

  • Nephrology Physician
  • New Smyrna Beach, FL
National Provider Identifier
1932425865
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
157715 Issued in MS
Practice address
1055 N Dixie Fwy Ste 1
New Smyrna Beach, FL 32168-6200
Phone
(386) 423-0505
Fax
(386) 423-0515
NPI assigned
Apr 16, 2010
Last updated
Sep 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X ME157715 FL
Nephrology Physician 207RN0300X 157715 MS Primary

Addresses

Primary practice location

1055 N Dixie Fwy Ste 1
New Smyrna Beach, FL 32168-6200

Mailing address

1055 N Dixie Fwy Ste 1
New Smyrna Beach, FL 32168-6200
Phone (386) 423-0505

Other identifiers 1

IdentifierTypeStateIssuer
114852900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20220715001980 FL Practitioner - Critical Care (Intensivists) 2163731118 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1055 N Dixie Fwy
Suite 1
New Smyrna Beach, FL 32168-6200
Phone 38642305051238

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME157715FLMDCritical Care Medicine (Internal Medicine) Physician
157715MSMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PCCC of Volusia LLC Critical Care Medicine CurrentSince Jul 13, 2022 Accepting new patients
NCCC of Volusia LLC Critical Care Medicine CurrentSince Jan 1, 2024 Accepting new patients

Locations

1055 N Dixie Fwy
Ste 1
New Smyrna Beach, FL 32168
Phone (386) 423-0505

780 Dunlawton Ave
Ste 1
Port Orange, FL 32127
Phone (386) 222-6111

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71631
  • Direct secure messaging: jorge.castaneda@pccc.directbygreenway.com

Organizations & group practices 2

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 5

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": "1271376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1932425865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N DIXIE FWY STE 1",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686200",
            "telephone_number": "386-423-0505",
            "fax_number": "386-423-0515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N DIXIE FWY STE 1",
            "city": "NEW SMYRNA BEACH",
            "state": "FL",
            "postal_code": "321686200",
            "telephone_number": "386-423-0505",
            "fax_number": "386-423-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTANEDA",
        "first_name": "JORGE",
        "middle_name": "LUIS",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-16",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "FL",
            "license": "ME157715",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MS",
            "license": "157715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114852900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Smyrna Beach, FL

Sources for this page

Verify at the official NPI Registry.