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MR. LUIS ANTONIO CACERES VILLALTA M.D.
NPI 1053803742
Family Medicine - Adult Medicine in Corona, NY

Active since May 30, 2018PECOS Enrolled
3716 108TH ST, CORONA, NY 11368(718) 651-4000 Get Directions Write a Review

NPPES record last updated: July 7, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 7, 2021, Aug 2, 2018 (2 updates tracked since 2018).

About Mr. Luis Antonio Caceres Villalta M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. LUIS ANTONIO CACERES VILLALTA M.D. (NPI 1053803742) is an individual adult medicine provider in Corona, New York, licensed in New York (310925-01) and active in the NPI registry since May 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053803742
Entity TypeIndividualMale
Primary Taxonomy207QA0505X
Provider Legal NameMR. LUIS ANTONIO CACERES VILLALTACredential: M.D.
Location Address3716 108TH STCorona, NY 11368-2025
Mailing Address3716 108th StCorona, NY 11368-2025 · (718) 651-4000
Phone(718) 651-4000
Sole ProprietorNo
Enumeration DateMay 30, 2018
Last NPPES UpdateJuly 7, 20212 updates tracked since enumeration
NPPES CertifiedJuly 7, 2021
✔ NPI 1053803742 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
License✔ Licensed in NY · 310925-01
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
3716 108TH ST, Corona, NY 11368
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Luis Antonio Caceres Villalta M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Luis Caceres Villalta reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Urban Health Plan, Inc.
Same address
Federally Qualified Health Center (FQHC)
3716 108TH ST
Corona, NY 11368
  • Reassigned Medicare billing, New York enrollment
  • 197 clinicians in this Medicare group
NPI 1710125141 (718) 651-4000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11368 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$104.17 typical visit price
range $67.00 – $201.98
Typical copayment $26.04 (range $16.75 – $50.49)
Most-billed visit code 99203
Established Patient
$116.96 typical visit price
range $21.62 – $163.52
Typical copayment $29.24 (range $5.40 – $40.88)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MATTHEW KUSHER M.D.
Family Medicine
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000
MS. MARGARITA LOPERA RD-N
Dietitian, Registered
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000
MS. CAROLINE LEUNG PA-C, RD
Physician Assistant
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000
CHRISTIAN DIAZ
Physician Assistant
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000
DR. IRFAN JADAVJI M.D.
Family Medicine
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000
MARCUS ARROYO PA-C
Physician Assistant
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000
DR. MARISSA GLORIA CARDILLO MD
Pediatrics
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000
ELIZABETH ARIAS M.D.
Pediatrics
3716 108TH ST
CORONA, NY 11368
Queens County (718) 651-4000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Luis Caceres Villalta's NPI number?

The NPI number for Luis Caceres Villalta is 1053803742. It was assigned to this individual provider in the NPPES registry on May 30, 2018.

Where is Luis Caceres Villalta located?

Luis Caceres Villalta practices at 3716 108th St, Corona, NY 11368. The listed phone number is (718) 651-4000.

What is Luis Caceres Villalta's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Is Luis Caceres Villalta enrolled in Medicare?

Yes. Luis Caceres Villalta is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Luis Caceres Villalta's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Luis Caceres Villalta reassigns Medicare benefits to Urban Health Plan, Inc. (Corona, NY). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Luis Caceres Villalta's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Luis Caceres Villalta was last updated on July 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.