Carlos Mario Rivera Serrano, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

ME148629 Issued in FL

Practice address

1111 Kane Concourse Ste 111
Bay Harbor Islands, FL 33154-2039

Phone

(617) 755-9404

NPI assigned

Jul 23, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: criveraserrano13653@sih.direct-ci.com

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.

• Southern Illinois Medical Services, NFP

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment NPD

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1497910905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 KANE CONCOURSE STE 111",
            "city": "BAY HARBOR ISLANDS",
            "state": "FL",
            "postal_code": "331542039",
            "telephone_number": "617-755-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 KANE CONCOURSE STE 111",
            "city": "BAY HARBOR ISLANDS",
            "state": "FL",
            "postal_code": "331542039",
            "telephone_number": "617-755-9404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Financial Park",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629027537",
            "country_code": "US",
            "telephone_number": "618-351-9140",
            "fax_number": "618-351-9143",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2601 W Main St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011031",
            "country_code": "US",
            "telephone_number": "618-351-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIVERA SERRANO",
        "first_name": "CARLOS",
        "middle_name": "MARIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-23",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "036.139259",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "FL",
            "license": "ME148629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "criveraserrano13653@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "1400 Financial Park",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629027537",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "criveraserrano13653@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "1400 Financial Park",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629027537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Meredith Rasco, MS
• Steven J Resnick, D.O.
• Restore Medical Center LLC
• Right Path Behavioral Health Services, LLC.
• Anatoly Ripa, DDS
• Karen Rivera
• Robert a. Freedman, M.D., P.a.
• Ronny Aquinin MD PA
• Naomi Ruza, LM, CPM
• Gabriel Saavedra

• Plastic and Reconstructive Surgery Physician in Bay Harbor Islands, FL
• Providers in Bay Harbor Islands, FL by specialty
• Plastic and Reconstructive Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.

Verify at the official NPI Registry.