RAFAEL ABREU M.D
NPI 1265769822
Family Medicine in Hialeah, FL

Q: What is Rafael Abreu's NPI number?

The NPI number for Rafael Abreu is 1265769822. It was assigned to this individual provider in the NPPES registry on November 3, 2009.

Q: What is Rafael Abreu's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Rafael Abreu was last updated on January 31, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since November 03, 2009PECOS EnrolledAccepts Medicare Assignment

26.84/100

CMS Quality Rating

1435 W 49TH PL STE 500, HIALEAH, FL 33012(305) 392-0380(305) 603-9683 Get Directions Write a Review

NPPES record last updated: January 31, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 12, 2021, Jul 24, 2019, Apr 25, 2019 (3 updates tracked since 2019).

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About Rafael Abreu M.d NPPES

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

RAFAEL ABREU M.D (NPI 1265769822) is an individual family medicine provider in Hialeah, Florida, licensed in Florida (ME109733) and active in the NPI registry since November 2009. He is enrolled in Medicare PECOS, is affiliated with Jackson Health System, and is a graduate of Other (1989).

NPPES Registry Identity

NPI1265769822

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameRAFAEL ABREUCredential: M.D

Location Address1435 W 49TH PL STE 500Hialeah, FL 33012-3158

Mailing Address1490 W 49th Pl Ste 204Hialeah, FL 33012-3149 · (305) 392-0380 · Fax (305) 603-9683

Phone(305) 392-0380

Fax(305) 603-9683

Sole ProprietorYes

Medical School CMSOtherGraduated 1989

Enumeration DateNovember 3, 2009

Last NPPES UpdateJanuary 31, 20243 updates tracked since enumeration

NPPES CertifiedJanuary 31, 2024

✔ NPI 1265769822 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in FL · ME109733

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedHospitalistTaxonomy 208M00000X · License ME109733 (FL)

1435 W 49TH PL STE 500, Hialeah, FL 33012

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, AvMed and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Rafael Abreu M.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2567638737

PECOS Enrollment IDI20120110000698

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.

Areas of Expertise CMS Part B claims 25

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes 99309

A follow-up nursing facility visit per day is a daily check-in by a healthcare professional. This 25-minute visit typically involves monitoring your health progress, addressing any concerns, and adjusting treatment plans as necessary. It's a vital part of ensuring your ongoing wellbeing.

2,153 services134 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

797 services243 patients

Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, 20 minutes or more 99308

A follow-up nursing facility visit per day is a daily check-up service provided by healthcare professionals. It lasts around 15 minutes and involves assessing your health status, monitoring your recovery progress, and addressing any concerns you may have about your health or treatment.

662 services90 patients

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233

Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.

556 services238 patients

Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes 99348

An established patient home visit is a 25-minute appointment where a healthcare provider visits you at your home. This service is for patients who have previously been seen by the provider. It includes a check-up and discussion about your health concerns.

456 services96 patients

Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223

Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.

421 services351 patients

Hospital discharge day management, more than 30 minutes 99239

Hospital discharge day management over 30 minutes involves a detailed process to ensure a smooth transition from hospital to home. It includes final examinations, discussion of your hospital stay, post-discharge instructions, and coordinating follow-up care.

347 services300 patients

Transitional care management services for problem of high complexity 99496

Transitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.

173 services152 patients

Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

129 services124 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

104 services68 patients

Hospital discharge day management, 30 minutes or less 99238

Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.

97 services92 patients

Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more 99306

An initial nursing facility visit is your first meeting with your healthcare team at a nursing facility. Lasting typically 45 minutes, this appointment involves a comprehensive health assessment and the creation of your personalized care plan. It's a crucial step to ensure your health and well-being.

86 services72 patients

Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month 99490

Chronic care management services involve a healthcare professional directing clinical staff in managing your chronic conditions. This includes the first 20 minutes per month of services like medication management, care coordination, and health monitoring to help improve your health and quality of life.

73 services43 patients

Telephone medical discussion with physician, 21-30 minutes 99443

This service involves a 21-30 minute phone conversation with a physician. It's a chance for you to discuss your health concerns, symptoms or treatment plans. It's similar to an in-person consultation, but conducted over the phone for your convenience and safety.

70 services43 patients

Nursing facility discharge management, more than 30 minutes 99316

Nursing facility discharge management over 30 minutes is a comprehensive process where a healthcare team prepares you for leaving the facility. It involves creating a tailored plan, coordinating care, and ensuring a smooth transition to your next care setting.

42 services36 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

36 services25 patients

Initial hospital care with same-day admission and discharge with moderate level of medical decision making, per day, if using time, at least 70 minutes 99235

This service involves a brief hospital stay for a moderate health issue. You'll be admitted and discharged on the same day, typically within 50 minutes. It's a quick, efficient way to receive necessary care and medical attention.

30 services30 patients

Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a G0179

This procedure involves a doctor or approved practitioner reviewing your health status and re-certifying your need for Medicare-covered home health services. It includes communication with the home health agency and assessment of your health reports, even when you're not physically present.

30 services18 patients

Initial hospital care with same-day admission and discharge with high level of medical decision making, per day, if using time, at least 85 minutes 99236

This service involves a brief hospital stay for a serious health issue. Patients are admitted and discharged on the same day, typically within 55 minutes. It allows for close monitoring and immediate treatment, ensuring optimal care.

28 services28 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

26 services14 patients

Residence visit for established patient with straightforward medical decision making, per day, if using time, at least 15 minutes 99347

An established patient home visit is a service where a healthcare professional visits your home for a 15-minute check-up. It's designed for patients who have previously seen the professional. The visit may include basic health assessments and discussions about your ongoing care.

26 services20 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

21 services21 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

17 services17 patients

Nursing facility discharge day management, 30 minutes or less 99315

Nursing facility discharge day management involves organizing your transition from the nursing facility to your home or another facility. This service, taking 30 minutes or less, includes finalizing medical instructions, arranging follow-up care, and answering any questions.

14 services13 patients

Residence visit for new patient with moderate level of medical decision making, per day, if using time, at least 60 minutes 99344

A new patient home visit is a comprehensive service where a healthcare professional visits your home for about an hour. This visit includes an overall health assessment, discussion about your medical history, and planning for future healthcare needs. The goal is to understand your health status and provide personalized care.

12 services12 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Jackson Health System

Acute Care Hospitals · Miami, FL

1/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number100022

Location1611 NW 12th AveMiami, FL 33136 · Miami-Dade County

Emergency services Birthing friendly

South Miami Hospital

Acute Care Hospitals · South Miami, FL

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number100154

Location6200 SW 73rd StSouth Miami, FL 33143 · Miami-Dade County

Emergency services Birthing friendly

Keralty Hospital

Acute Care Hospitals · Miami, FL

1/5 CMS rating

OwnershipProprietary

CMS Certification Number100284

Location2500 SW 75th AveMiami, FL 33155 · Miami-Dade County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33012 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

$96.13 typical visit price

range $60.92 – $187.05

Typical copayment $24.03 (range $15.23 – $46.76)

Most-billed visit code 99203

Established Patient

$107.17 typical visit price

range $18.99 – $150.24

Typical copayment $26.79 (range $4.74 – $37.56)

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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

26.84/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Individually scored

Quality

Improvement Activities

Cost

36.15

Referred Medical Equipment & Supplies CMS DME claims 37

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each A4233

DME-Other DME · category DE017N

1 supplier18 claims36 services$0.39 avg. paid by Medicare

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

11 suppliers101 claims276 services$6.19 avg. paid by Medicare

Normal, low and high calibrator solution / chips A4256

DME-Other DME · category DE000N

2 suppliers46 claims46 services$2.69 avg. paid by Medicare

Spring-powered device for lancet, each A4258

DME-Other DME · category DE000N

4 suppliers20 claims20 services$1.72 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

10 suppliers80 claims122 services$1.07 avg. paid by Medicare

Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) A4314

DME-Orthotic Devices · category DF000N

3 suppliers16 claims16 services$20.77 avg. paid by Medicare

Tape, waterproof, per 18 square inches A4452

DME-Medical/Surgical Supplies · category DA000N

1 supplier14 claims992 services$0.37 avg. paid by Medicare

For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe A5500

DME-Orthotic Devices · category DF000N

2 suppliers39 claims78 services$59.94 avg. paid by Medicare

For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each A5512

DME-Orthotic Devices · category DF000N

2 suppliers38 claims220 services$24.44 avg. paid by Medicare

Collagen based wound filler, dry form, sterile, per gram of collagen A6010