Individual provider Active NPI

Raymond Ortiz Class, DMD

  • General Practice Dentistry
  • Carolina, PR
National Provider Identifier
1376540013
Registry record updated Nov 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2523 Issued in PR
Practice address
Roberto Clemente Ave
24 8 Villa Carolina
Carolina, PR 00985-5401
Phone
(787) 757-3080
Fax
(787) 757-1910
NPI assigned
Jul 7, 2005
Reactivated
Apr 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2020

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 2523 PR Primary

Addresses

Primary practice location

Roberto Clemente Ave
24 8 Villa Carolina
Carolina, PR 00985-5401

Mailing address

Ave Roberto Clemente
24 8 Villa Carolina
Carolina, PR 00985-5401
Phone (787) 757-3080

Other identifiers 1

IdentifierTypeStateIssuer
2523OtherPRMEDICAL LICENCES

Other names 1

  • Dr. Ortiz Class Raymond Professional name

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160504000016 PR Order and Referring Only - Other (Non-Physician) 6608175211

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2523PRMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1376540013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "AVE ROBERTO CLEMENTE",
            "address_2": "24 8 VILLA CAROLINA",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009855401",
            "telephone_number": "787-757-3080",
            "fax_number": "787-757-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROBERTO CLEMENTE AVE",
            "address_2": "24 8 VILLA CAROLINA",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009855401",
            "telephone_number": "787-757-3080",
            "fax_number": "787-757-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ CLASS",
        "first_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENCES",
            "identifier": "2523",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ORTIZ",
            "last_name": "RAYMOND",
            "middle_name": "CLASS",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Carolina, PR

Sources for this page

Verify at the official NPI Registry.