Active NPI
Evelyn De Jesus
- Dentist
- Rio Grande, PR
National Provider Identifier
1083710511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1913
- Practice address
- 41 Calle Pimentel
Rio Grande, PR 00745 - Phone
- (787) 888-1228
- Fax
- (787) 888-1228
- NPI assigned
- Sep 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1913 | PR | Primary |
Addresses
Primary practice location
41 Calle Pimentel
Rio Grande, PR 00745
Mailing address
PO Box 1694
Rio Grande, PR 00745
Phone (787) 888-1228
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160729001351 | PR | Order and Referring Only - Oral Surgery | 7315230281 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1913 | PR | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083710511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1694",
"city": "RIO GRANDE",
"state": "PR",
"postal_code": "00745",
"telephone_number": "787-888-1228",
"fax_number": "787-888-1228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 CALLE PIMENTEL",
"city": "RIO GRANDE",
"state": "PR",
"postal_code": "00745",
"telephone_number": "787-888-1228",
"fax_number": "787-888-1228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE JESUS",
"first_name": "EVELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PR",
"license": "1913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rio Grande, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.