Individual provider Active NPI

Santos Michael Rivera, PA-C

  • Surgical Physician Assistant
  • San Antonio, TX
National Provider Identifier
1154335792
Registry record updated Aug 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA01255 Issued in TX
Practice address
3463 Magic Dr Ste T21
San Antonio, TX 78229
Phone
(210) 614-8101
Fax
(210) 614-8102
NPI assigned
Jul 28, 2006
Last updated
Aug 8, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA01255 TX Primary

Addresses

Primary practice location

3463 Magic Dr Ste T21
San Antonio, TX 78229

Mailing address

3463 Magic Dr Ste T21
San Antonio, TX 78229-3621
Phone (210) 614-8101

Other practice location 1

600 Westwood Dr
Sherman, TX 75092-5667
Phone (903) 870-6605

Other identifiers 1

IdentifierTypeStateIssuer
88N947OtherTXBCBS OF TEXAS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050303000763 TX Practitioner - Physician Assistant 3476507328 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Antonio Assisting Services, LLCGroup PAC ID 6002952314, 4 clinicians

Practice addresses (Care Compare)

3463 Magic Dr
Suite T21
San Antonio, TX 78229-3621
Phone (210) 614-8101

8026 Floyd Curl Dr
San Antonio, TX 78229-3915
Phone (210) 575-8110

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA01255TXMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiothoracic Surgical Associates PastSince Feb 2, 2020 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565222400000",
    "number": "1154335792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3463 MAGIC DR STE T21",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293621",
            "telephone_number": "210-614-8101",
            "fax_number": "210-614-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3463 MAGIC DR STE T21",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78229",
            "telephone_number": "210-614-8101",
            "fax_number": "210-614-8102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Westwood Dr",
            "address_purpose": "LOCATION",
            "city": "Sherman",
            "state": "TX",
            "postal_code": "750925667",
            "country_code": "US",
            "telephone_number": "903-870-6605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "SANTOS",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2019-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA01255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "88N947",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.