Individual provider Active NPI

Ivan Cardona Miranda

  • Anesthesiology Physician
  • Bayamon, PR
National Provider Identifier
1215030176
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
6474 Issued in PR
Practice address
Calle Sta Cruz #70 Urb Sta Cruz
Bayamon, PR 00959
Phone
(787) 620-9581
NPI assigned
Sep 6, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

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
Anesthesiology Physician 207L00000X 6474 PR Primary

Addresses

Primary practice location

Calle Sta Cruz #70 Urb Sta Cruz
Bayamon, PR 00959

Mailing address

PO Box 379
Dorado, PR 00646-0379
Phone (787) 620-9581

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
I20051214000084 PR Practitioner - Anesthesiology 9537128830 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6474PRMDMedical license number

Practice roles

OrganizationSpecialtyStatusNew patients
Mennonite General Hospital Inc CurrentSince Apr 1, 2018 Accepting new patients
Mennonite General Hospital Inc. CurrentSince Apr 1, 2018 Accepting new patients
Mennonite General Hospital Inc Current 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.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215030176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 379",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "006460379",
            "telephone_number": "787-620-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE STA CRUZ #70 URB STA CRUZ",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "00959",
            "telephone_number": "787-620-9581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDONA MIRANDA",
        "first_name": "IVAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PR",
            "license": "6474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayamon, PR

Sources for this page

Verify at the official NPI Registry.