Daniel T Ceballos, AGNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2024026725 Issued in MO

Practice address

12655 Olive Blvd FL 4
Saint Louis, MO 63141-6291

Phone

(314) 394-7444

Fax

(314) 627-8957

NPI assigned

Aug 1, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Care Health CentersGroup PAC ID 7911815097, 53 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Family Care Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1508867508

  MO

  Medicare reassignment Care Compare group NPD
• Vpa PC

  • Family Medicine Physician
  • Saint Louis, MO
  • NPI 1760706337

  MO

  Medicare reassignment NPD
• Family Care Health Centers

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1023285624
  Care Compare group NPD
• Vpa PC

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD
• Esse Health Heal at Home LLC

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1801518592

  Adult Health

  NPD (past)

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

{
    "created_epoch": "1722470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1992535330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410770",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631410770",
            "telephone_number": "314-851-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12655 OLIVE BLVD FL 4",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416291",
            "telephone_number": "314-394-7444",
            "fax_number": "314-627-8957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEBALLOS",
        "first_name": "DANIEL",
        "middle_name": "T",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2024026725",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2024026725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• CCM Operations, LLC
• Cde Consumer Directed Services Inc
• Cde Health Care Services
• CDS Express LLC
• CDS of Saint Louis LLC
• Forrest Ceballos, LCSW
• Kady Sue Cecena, FNP
• Ceg SNF Opco LLC
• Gregory Peter Cejas, MD
• Nurfeta Cejvanovic, BA

• All providers in Saint Louis, MO
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.