Individual provider Active NPI

Carolyn Otero Rivera

  • Internal Medicine Physician
  • Ponce, PR
National Provider Identifier
1467413328
Registry record updated Feb 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
12838 Issued in PR
Practice address
Urb Valle Verde - Paseo Real #1014
Suite 1
Ponce, PR 00716-3500
Phone
(787) 284-0574
Fax
(787) 284-0574
NPI assigned
Mar 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 12838 PR Primary

Addresses

Primary practice location

Urb Valle Verde - Paseo Real #1014
Suite 1
Ponce, PR 00716-3500

Mailing address

PO Box 76- Mercedita
Ponce, PR 00715-0076
Phone (787) 284-0574

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140409002234 PR Practitioner - Internal Medicine 3577795384 Practice locations: Morovis, PR; Ponce, PR

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Urb Valle Verde
1014 Paseo Real Suite 1
Ponce, PR 00716-3500
Phone (787) 284-0574

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12838PRMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
C & M Internal Medicine, PSC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393372800000",
    "number": "1467413328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 76- MERCEDITA",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007150076",
            "telephone_number": "787-284-0574",
            "fax_number": "787-284-0574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "URB VALLE VERDE - PASEO REAL #1014",
            "address_2": "SUITE 1",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007163500",
            "telephone_number": "787-284-0574",
            "fax_number": "787-284-0574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTERO RIVERA",
        "first_name": "CAROLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-30",
        "last_updated": "2014-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PR",
            "license": "12838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.