Individual provider Active NPI

Rigoberto Gonzalez Jimenez, MD

  • General Practice Physician
  • Dorado, PR
National Provider Identifier
1114457009
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
19655 Issued in PR
Practice address
Street 695 KM 2.0, Urb. Doraville Office 2
Dorado, PR 00646
Phone
(939) 325-2945
Fax
(939) 333-2169
NPI assigned
Jun 14, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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 19655 PR Primary

Addresses

Primary practice location

Street 695 KM 2.0, Urb. Doraville Office 2
Dorado, PR 00646

Mailing address

97 Plaza Carmen
Vega Alta, PR 00692-9128
Phone (939) 325-2945

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
I20180117000591 PR Practitioner - Family PracticePractitioner - General Practice 8921367160 Reassigns benefits to 1 organization
Practice locations: Toa Alta, PR

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19655PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MD Premier Health LLC General Practice CurrentSince Jun 4, 2024 Accepting new patients

Organizations & group practices 1

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": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1114457009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 PLAZA CARMEN",
            "city": "VEGA ALTA",
            "state": "PR",
            "postal_code": "006929128",
            "telephone_number": "939-325-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STREET 695 KM 2.0, URB. DORAVILLE OFFICE 2",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "00646",
            "telephone_number": "939-325-2945",
            "fax_number": "939-333-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ JIMENEZ",
        "first_name": "RIGOBERTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-14",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "19655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorado, PR

Sources for this page

Verify at the official NPI Registry.