Mario Remedios Ortiz, PHD; PHCNS-BC, FNP-C

Primary specialty

Community Health/Public Health Clinical Nurse SpecialistTaxonomy code 364SC1501X

License

71005395A Issued in IN

Practice address

1700 Mishawaka Ave # Sac-130
Health & Wellness Center, Iu South Bend
South Bend, IN 46615-1408

Phone

(574) 520-5557

Fax

(574) 520-5042

NPI assigned

Mar 26, 2015

Last updated

Jul 30, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Reach Medical PLLCGroup PAC ID 8123381993, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17251/brand/1/csg/1/fhir/r4
• Direct secure messaging: mario.ortiz.1@17251.direct.athenahealth.com

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.

• Reach Medical PLLC

  • General Practice Physician
  • Ithaca, NY
  • NPI 1831601533
  Medicare reassignment Care Compare group NPD
• Indiana University South Bend Health & Wellness Center

  • Internal Medicine Physician
  • South Bend, IN
  • NPI 1952721185
  Authorized official Same address or phone
• The Reach Project Inc

  dba Reach Medical

  • General Practice Physician
  • Ithaca, NY
  • NPI 1124648316
  NPD

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438214400000",
    "number": "1265826226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 MISHAWAKA AVE # SAC-130",
            "address_2": "HEALTH & WELLNESS CENTER, IU SOUTH BEND",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466151408",
            "telephone_number": "574-520-5557",
            "fax_number": "574-520-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MISHAWAKA AVE # SAC-130",
            "address_2": "HEALTH & WELLNESS CENTER, IU SOUTH BEND",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466151408",
            "telephone_number": "574-520-5557",
            "fax_number": "574-520-5042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ",
        "first_name": "MARIO",
        "middle_name": "REMEDIOS",
        "credential": "PHD; PHCNS-BC, FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-26",
        "last_updated": "2015-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71005395A",
            "primary": false
        },
        {
            "code": "364SC1501X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Community Health/Public Health",
            "state": "IN",
            "license": "71005395A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Michelle Orta
• Jerelle Orta
• Maria Orta
• Orthopedic Medical Group, Inc.
• Diana C Ortiz
• Mary Jean Osberger, LCSW
• Lydia Grace Oscarson
• Crystal Osler
• Elisa Osler, PHARMD
• Patricia C Osmolak, M.D.

• Clinical Nurse Specialist in South Bend, IN
• Providers in South Bend, IN by specialty
• Clinical Nurse Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; 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.