DR. PEDRO RAUL VILLANUEVA M.D.
NPI 1851459606
Pediatrics in Arcadia, FL

NPI Status: Active since December 05, 2006

Contact Information

888 N ROBERT AVE
ARCADIA, FL
ZIP 34266
Phone: (863) 494-8410
Fax: (863) 491-5306

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Quality Reporting
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Individual
Male
Pediatrics
Accepts Insurance
Medicare Quality Reporting

About PEDRO VILLANUEVA

This page provides the complete NPI Profile along with additional information for Pedro Villanueva, a pediatrician established in Arcadia, Florida with a medical specialization in Pediatrics. The healthcare provider is registered in the NPI registry with number 1851459606 assigned on December 2006. The practitioner's primary taxonomy code is 208000000X with license number ME50602 (FL). The provider is registered as an individual and his NPI record was last updated 3 years ago.

NPI: 1851459606
Provider Name: DR. PEDRO RAUL VILLANUEVA M.D.
Gender: Male
Entity Type: Individual
Location Address: 888 N ROBERT AVE ARCADIA, FL 34266
Location Phone: (863) 494-8410
Location Fax: (863) 491-5306
Mailing Address: 700 8TH AVE W STE 101 PALMETTO, FL 34221
Mailing Phone: (941) 776-4008
Mailing Fax: (863) 491-5306
Is Sole Proprietor?: Yes
Enumeration Date: 12-05-2006
Last Update Date: 03-07-2023
Code Navigator

A pediatrician like Pedro Villanueva is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Pediatrics
Taxonomy Code: 208000000X
Type: Allopathic & Osteopathic Physicians
License No.: ME50602
License State: FL
Taxonomy Description: A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Superior HealthPlan

Complete VALUE Gold - HMO
Focused VALUE Silver - HMO
Focused VALUE Silver + Vision + Adult Dental - HMO
Standard Gold VALUE - HMO
Standard Silver VALUE - HMO
Standard Silver VALUE + Vision + Adult Dental - HMO

Ambetter Health

Clarity Silver - HMO
Clarity VALUE Silver - HMO
Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Complete VALUE Gold - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite VALUE Bronze - HMO
Enhanced Diabetes Care Silver with $0 Drug Options - HMO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - HMO

Ambetter of Alabama

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO

Florida Blue (BlueCross BlueShield FL)

BlueOptions Bronze (HSA) 24J01-10 (Rewards / $4 Condition Care Rx) - PPO
BlueOptions Bronze 24J01-04 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - PPO
BlueOptions Bronze 24J01-06 (Rewards) - PPO
BlueOptions Bronze 24J01-17 ($50 PCP Visits / Rewards) - PPO
BlueOptions Bronze 24J01-18S ($50 PCP Visits / Rewards) - PPO
BlueOptions Gold 24J01-09 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards) - PPO
BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) - PPO
BlueOptions Gold 24J01-20S ($30 PCP Visits / $60 Specialist Visits / Rewards) - PPO
BlueOptions Platinum 24J01-05 ($0 Labs / $15 PCP Visits / $35 Specialist Visits / Rewards) - PPO
BlueOptions Platinum 24J01-08 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards) - PPO

Florida Blue HMO (a BlueCross BlueShield FL company)

BlueCare Bronze (HSA) 24K01-09 (Rewards / $4 Condition Care Rx) - POS
BlueCare Bronze 24K01-03 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K01-05 (Rewards) - POS
BlueCare Bronze 24K01-25 ($50 PCP Visits / $75 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K01-31S ($50 PCP Visits / Rewards) - POS
BlueCare Bronze 24K02-17 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K02-18 (Rewards) - POS
BlueCare Bronze 24K02-23 ($50 PCP Visits / $75 Specialist Visits / Rewards) - POS
BlueCare Bronze 24K02-26S ($50 PCP Visits / Rewards) - POS
BlueCare Gold 24K01-08 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards) - POS

Wellpoint

Wellpoint Essential Bronze 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
Wellpoint Essential Bronze 5500 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
Wellpoint Essential Bronze 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
Wellpoint Essential Bronze 7500 ($0 Virtual PCP + $0 Select Drugs + Incentives) Standard - HMO
Wellpoint Essential Catastrophic (+ Incentives) - HMO
Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
Wellpoint Essential Gold 2000 ($0 Virtual PCP + $0 Select Drugs + Incentives) Standard - HMO
Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
Wellpoint Essential Gold 800 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
Wellpoint Essential Silver 1850 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
046388400	MEDICAID (05)	FL

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

Quality Measure	Performance	Number of Patients
Chronic Care and Preventative Care Management for Empaneled Patients	Yes	N/A
Proactively manage chronic and preventive care for empaneled patients that could include one or more of the following: • Provide patients annually with an opportunity for development and/or adjustment of an individualized plan of care as appropriate to age and health status, including health risk appraisal; gender, age and condition-specific preventive care services; and plan of care for chronic conditions; • Use condition-specific pathways for care of chronic conditions (e.g., hypertension, diabetes, depression, asthma and heart failure) with evidence-based protocols to guide treatment to target; such as a CDC-recognized diabetes prevention program; • Use pre-visit planning to optimize preventive care and team management of patients with chronic conditions; • Use panel support tools (registry functionality) to identify services due; • Use predictive analytical models to predict risk, onset and progression of chronic diseases; or • Use reminders and outreach (e.g., phone calls, emails, postcards, patient portals and community health workers where available) to alert and educate patients about services due; and/or routine medication reconciliation.
Closing the Referral Loop: Receipt of Specialist Report	62%	400
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred
e-Prescribing	99%	2948
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
Health Information Exchange	12%	488
The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Immunization Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data.
Implementation of medication management practice improvements	Yes	N/A
Manage medications to maximize efficiency, effectiveness and safety that could include one or more of the following: Reconcile and coordinate medications and provide medication management across transitions of care settings and eligible clinicians or groups; Integrate a pharmacist into the care team; and/or Conduct periodic, structured medication reviews.
Measurement and Improvement at the Practice and Panel Level	Yes	N/A
Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level.
Medication Reconciliation	100%	409
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
Patient-Specific Education	91%	2865
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	59%	22
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2
Preventive Care and Screening: Screening for Depression and Follow-Up Plan	94%	652
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen
Provide Patient Access	100%	2865
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information.
Secure Messaging	8%	2865
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative) during the performance period.
Security Risk Analysis	Yes	N/A
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process.
Specialized Registry Reporting	Yes	N/A
The MIPS eligible clinician is in active engagement to submit data to specialized registry. To earn a 5 % bonus in the promoting interoperability performance category score for submitting to one or more public health or clinical data registries also attest to PI_TRANS_PHCDRR_3_MULTI.
Use of decision support and standardized treatment protocols	Yes	N/A
Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1851459606, we treat the final digit (6) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 64. The final step is to find the difference between that total and the next multiple of ten (70 - 64 = 6).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 10 → 1 + 0

Pos 4

Unchanged

Pos 5

Doubled → 8

Pos 6

Unchanged

Pos 7

Doubled → 18 → 1 + 8

Pos 8

Unchanged

Pos 9

Doubled → 0

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 5 → 10 → 1 4 → 8 9 → 18 → 9 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 8 + 1 + 0 + 1 + 8 + 5 + 1 + 8 + 6 + 0 + 24 = 64

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 64 is 70. The difference is the calculated check digit.

70 - 64 = 6

This NPI is valid

The calculated check digit is 6, which matches the last digit of 1851459606.