Individual provider Active NPI

Jesse N. Rivera, PA-C

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1174404750
Registry record updated Jun 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0012330 Issued in DE
Practice address
4755 Ogletown Stanton Rd Ste 1E50
Newark, DE 19718-2200
Phone
(302) 733-1980
Fax
(302) 733-1986
NPI assigned
Sep 10, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0012330 DE Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd Ste 1E50
Newark, DE 19718-2200

Mailing address

4755 Ogletown Stanton Rd Ste 1E50
Newark, DE 19718-2200
Phone (302) 733-1980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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
I20250924003338 DE Practitioner - Physician Assistant 3173028826 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4000 Nexus Dr
Wilmington, DE 19803-3000

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Sep 10, 2025 Accepting new patients
Christiana Care Health Services Inc CurrentSince Sep 10, 2025 Accepting new patients

Locations

4745 Stanton Ogletwn Rd
Newark, DE 19713
Phone (302) 623-7600

4755 Ogletown Stanton Rd
#1E50
Newark, DE 19718
Phone (302) 733-1980

4755 Ogletown Stanton Rd
Fl 3
Newark, DE 19718
Phone (302) 733-3475

4755 Ogletown Stanton Rd
Ste 1E50
Newark, DE 19718
Phone (302) 733-1980

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

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": "1757462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781740800000",
    "number": "1174404750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 1E50",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-1980",
            "fax_number": "302-733-1986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 1E50",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-1980",
            "fax_number": "302-733-1986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "JESSE",
        "middle_name": "N.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-10",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0012330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.