Active NPI
Edgardo Rivera, DMD
- General Practice Dentistry
- Manati, PR
National Provider Identifier
1366415093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1660
- Practice address
- 4 Calle Vendig
Manati, PR 00674-5327 - Phone
- (787) 854-6759
- NPI assigned
- Feb 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1660 | PR | Primary |
Addresses
Primary practice location
4 Calle Vendig
Manati, PR 00674-5327
Mailing address
4 Calle Vendig
Manati, PR 00674-5327
Phone (787) 854-6759
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41556 | Other | PR | SSS PROVIDER ID |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150824000547 | PR | Order and Referring Only - Oral Surgery | 0244545002 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366415093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 CALLE VENDIG",
"city": "MANATI",
"state": "PR",
"postal_code": "006745327",
"telephone_number": "787-854-6759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 CALLE VENDIG",
"city": "MANATI",
"state": "PR",
"postal_code": "006745327",
"telephone_number": "787-854-6759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "EDGARDO",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "PR",
"license": "1660",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SSS PROVIDER ID",
"identifier": "41556",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manati, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.