Rene S Mediavillo, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

136585 Issued in NY

Practice address

9202 Liberty Ave
Ozone Park, NY 11417-1526

Phone

(718) 835-9729

Fax

(718) 925-9817

NPI assigned

Nov 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Radiation Oncology

Education

Other, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New York Radiation Oncology Associates, PC

  • Specialist
  • Ozone Park, NY
  • NPI 1215159603
  Medicare reassignment NPD Authorized official
• Metropolitan Radiation, PC

  • Radiation Oncology Physician
  • Brooklyn, NY
  • NPI 1114962511
  NPD (past)
• Northern Boulevard Radiation Oncology LLP

  • Radiation Oncology Physician
  • Flushing, NY
  • NPI 1700884202
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376622019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9202 LIBERTY AVE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114171526",
            "telephone_number": "718-835-9729",
            "fax_number": "718-925-9817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9202 LIBERTY AVE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114171526",
            "telephone_number": "718-835-9729",
            "fax_number": "718-925-9817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDIAVILLO",
        "first_name": "RENE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "136585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "136585",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00589464",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loraine Juanita McKenzie
• Nyasia McKinstry
• Melissa McLaughlin, OTR/L
• Medaid Pharmacy Inc.
• Medi Prime Pharmacy Inc,
• Medrite RX Inc
• Medsys DME LLC
• Medtech Consulting
• Meera S. Boppana,MD.PC
• Meghna Pharmacy Inc

• Specialist in Ozone Park, NY
• Providers in Ozone Park, NY by specialty
• Specialist in New York

• 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.