Jaime Alberto Pedraza, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2063 Issued in PR

Practice address

Calle1 HH1 Riverview
Bayamon, PR 00962-6070

Phone

(787) 275-0605

NPI assigned

Jul 11, 2006

Last updated

Sep 8, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1033143102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 CALLE MUNOZ RIVERA",
            "city": "BARRANQUITAS",
            "state": "PR",
            "postal_code": "007941602",
            "telephone_number": "787-450-6599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE1 HH1 RIVERVIEW",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009626070",
            "telephone_number": "787-275-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDRAZA",
        "first_name": "JAIME",
        "middle_name": "ALBERTO",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIPLE S",
            "identifier": "041784",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST MEDICAL",
            "identifier": "6954",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "7940004",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCS LIFE",
            "identifier": "1033143102",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PLAN DE SALUD HOSPITAL ME",
            "identifier": "D00103",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pearle Vision Center of Puerto Rico, Inc
• Pediatria Buena Vista CSP
• Pediatric & General Dental Services Corp.
• Pediatric Dental Services PSC
• Pediatrics & Sports Medicine P.S.C.
• Dora Isella Pedrosa, MD
• Norberto Pellot, M.D
• Rosalyn Pena Gonzalez, DR
• Estefany Pena Hilario, MD, RDMS, SG
• Nayda Y Pena-Ramos, R.PH.

• General Practice Dentistry in Bayamon, PR
• Providers in Bayamon, PR by specialty
• General Practice Dentistry in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.