Individual provider Active NPI

Ernesto J Roman, MD

  • General Practice Physician
  • Vega Baja, PR
National Provider Identifier
1104928423
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
13768 Issued in PR
Practice address
Carr. #2, KM 40.2 , Plaza Jardines
Suite # 3
Vega Baja, PR 00693
Phone
(787) 855-0411
Fax
(787) 855-0285
NPI assigned
Sep 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 13768 PR Primary

Addresses

Primary practice location

Carr. #2, KM 40.2 , Plaza Jardines
Suite # 3
Vega Baja, PR 00693

Mailing address

425 Carr 693
PMB 137
Dorado, PR 00646-4802
Phone (787) 270-6082

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050719000763 PR Practitioner - General Practice 1759318009 Practice locations: Mayaguez, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
13768PRMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Mayaguez Inc Past Accepting new patients
Hospital San Antonio Inc Past Accepting new patients
Mayaguez Medical Center - San Antonio Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104928423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 CARR 693",
            "address_2": "PMB 137",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "006464802",
            "telephone_number": "787-270-6082",
            "fax_number": "787-855-0285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR. #2, KM 40.2 , PLAZA JARDINES",
            "address_2": "SUITE # 3",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "00693",
            "telephone_number": "787-855-0411",
            "fax_number": "787-855-0285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMAN",
        "first_name": "ERNESTO",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "13768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vega Baja, PR

Sources for this page

Verify at the official NPI Registry.