Individual provider Active NPI

Antonio Ragay Amor, M.D.

  • Family Medicine Physician
  • Long Beach, CA
National Provider Identifier
1205868262
Registry record updated Mar 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
200100999 Issued in NC
Practice address
3559 E South St Ste B
Long Beach, CA 90805-4519
Phone
(704) 366-7584
Fax
(704) 364-2417
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 200100999 NC Primary

Addresses

Primary practice location

3559 E South St Ste B
Long Beach, CA 90805-4519

Mailing address

3559 E South St Ste B
Long Beach, CA 90805-4519
Phone (704) 366-7584

Other identifiers 2

IdentifierTypeStateIssuer
891292VMedicaidNC
1292VOtherNCBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200100999NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients
Union Urgent Care LLC Family Medicine Past Accepting new patients
Carolinas Physicians Network Inc Past Accepting new patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients

Organizations & group practices 4

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1205868262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3559 E SOUTH ST STE B",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908054519",
            "telephone_number": "704-366-7584",
            "fax_number": "704-364-2417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3559 E SOUTH ST STE B",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908054519",
            "telephone_number": "704-366-7584",
            "fax_number": "704-364-2417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMOR",
        "first_name": "ANTONIO",
        "middle_name": "RAGAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "200100999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891292V",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1292V",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.