Ivelisse Pena Jimeno, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

12440 Issued in PR

Practice address

346 Calle 32
Villa Nevarez
San Juan, PR 00927-5111

Phone

(787) 751-2653

NPI assigned

Jan 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Specialty

General Practice

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Condado Hospice Program Inc Hospice, San Juan, PR, CCN 401521

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

• Condado Hospice Program, Inc

  • Community Based Hospice Care Agency
  • Hato Rey, PR
  • NPI 1750382743
  Care Compare affiliation

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1225174816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51320",
            "city": "TOA BAJA",
            "state": "PR",
            "postal_code": "009501320",
            "telephone_number": "787-751-2653",
            "fax_number": "787-753-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 CALLE 32",
            "address_2": "VILLA NEVAREZ",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009275111",
            "telephone_number": "787-751-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA JIMENO",
        "first_name": "IVELISSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PR",
            "license": "12440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIPLE S",
            "identifier": "20041",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MMM",
            "identifier": "500475E",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "9270157",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PMC",
            "identifier": "2499",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST MEDICAL",
            "identifier": "5234",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Khalil Pellicier Rodriguez, LPN
• Joel E Pellot Cestero, M.D.
• Victoria Pellot Ortiz
• Pelvic Solution Institute, LLC
• Katherine Pena Castillo, PA
• Jennifer M Pena Moreira, M.D.
• Kathia M Pena Rios, PHD
• Alba Janice Pena Rivera, MSW
• Jorge L Pena Ruiz I, MD
• Emmanuel Jose Pena Serrano, PH.D.

• Family Medicine Physician in San Juan, PR
• Providers in San Juan, PR by specialty
• Family Medicine Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.