ANTONIO CARABALLO – Psychiatric/Mental Health Nurse Practitioner, NPI 1063209229

ANTONIO CARABALLO is a healthcare provider. based in Philadelphia, Pennsylvania. specializing in NURSE PRACTITIONER. They hold a License No. 26NJ15349700 (NJ). The NPI Number for ANTONIO CARABALLO is 1063209229

Main info

Male
Sole Proprietor
1 Year Of Experience
Accepts Medicare Assignment
Name
ANTONIO CARABALLO
NPI
1063209229
Phone
Not provided
Address
2409 S LEE ST
Enumeration Date
22 April 2025
Last Update Date
7 May 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6094551576
Graduation Year
2025 (1 year ago)
PAC ID
4587150131
Group Practice PAC ID
6103257571
Professional Enrollment ID
I20260102001502
Address ID
NJ080622665MU507XXRDXX400
Data current as of
3 June 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience35
Completeness85
Years active:1State licenses:2Digital endpointsOther names

11,473 NURSE PRACTITIONER in PA

Provider Addresses for ANTONIO CARABALLO

  • 2409 S LEE ST

    PHILADELPHIA, PA 191484105

    Phone:

    Type: Mailing

  • 618 W LEHIGH AVE

    PHILADELPHIA, PA 191332227

    Phone: (215) 229-8857

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2026-01-28

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20260102001502INurse PractitionerNJTBD
I20260128003243INurse PractitionerPATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 19148)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6103257571View full group profile
NameSpecialtyState
Nurse PractitionerNJ
Internal MedicineNJ
Nurse PractitionerNJ
Nurse PractitionerNJ
Internal MedicineNJ
Hospitalist, Internal Medicine, Internal MedicineNJ
Internal MedicineNJ
Nurse PractitionerNJ
Nurse PractitionerNJ
Nurse PractitionerNJ

Reviews

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Frequently asked questions

Where can patients find ANTONIO CARABALLO's NPI?
You can confirm ANTONIO CARABALLO with NPI 1063209229; it appears in the national provider directory.
Is ANTONIO CARABALLO active in the national directory?
ANTONIO CARABALLO's public NPI profile is in an active state.
What does ANTONIO CARABALLO treat or focus on?
Patients typically see ANTONIO CARABALLO under the specialty Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where is ANTONIO CARABALLO's primary listing?
We display Philadelphia, Pennsylvania because that is what the record indicates for ANTONIO CARABALLO.
Is ANTONIO CARABALLO a real provider?
This page reflects official NPPES data for NPI 1063209229. Always confirm identity and privileges with the practice and licensing boards.