Individual provider Active NPI

Derrick Rizziello, DMD

  • General Practice Dentistry
  • Leesburg, FL
National Provider Identifier
1235559410
Registry record updated Jan 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN 20541 Issued in FL
Practice address
949 N 14TH St
Leesburg, FL 34748-3838
Phone
(352) 460-0164
NPI assigned
Apr 25, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN 20541 FL Primary

Addresses

Primary practice location

949 N 14TH St
Leesburg, FL 34748-3838

Mailing address

949 N 14TH St
Leesburg, FL 34748-3838
Phone (352) 460-0164

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150530000054 FL Order and Referring Only - DentistPractitioner - Dentist 3072834290

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN 20541FLMDGeneral Practice Dentistry

Networks

  • Freedom Health HMO Network

NPI Registry JSON

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420156800000",
    "number": "1235559410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "949 N 14TH ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483838",
            "telephone_number": "352-460-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "949 N 14TH ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347483838",
            "telephone_number": "352-460-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIZZIELLO",
        "first_name": "DERRICK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-25",
        "last_updated": "2015-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 20541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.