Active NPI
Antonio E Puente, PHD
- Clinical Neuropsychologist
- Wilmington, NC
National Provider Identifier
1508968843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- NC0831
- Practice address
- 1508 Military Cutoff Road
Ste 303
Wilmington, NC 28403 - Phone
- (910) 509-9371
- Fax
- (910) 509-9372
- NPI assigned
- Sep 5, 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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | NC0831 | NC | Primary |
Addresses
Primary practice location
1508 Military Cutoff Road
Ste 303
Wilmington, NC 28403
Mailing address
1508 Military Cutoff Road
Ste 303
Wilmington, NC 28403
Phone (910) 509-9371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04461 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110310000819 | NC | Practitioner - Clinical Psychologist | 8022290139 | Practice locations: Wilmington, NC |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1508 Military Cutoff Rd
Suite 303
Wilmington, NC 28403-5730
Phone (910) 509-9371
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NC0831 | NC | MD | Clinical Neuropsychologist |
| 831 | NC | MD | Chiropractor |
Interoperability endpoints
- antonio.puente.1@14070.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437436800000",
"number": "1508968843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1508 MILITARY CUTOFF ROAD",
"address_2": "STE 303",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "28403",
"telephone_number": "910-509-9371",
"fax_number": "910-509-9372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1508 MILITARY CUTOFF ROAD",
"address_2": "STE 303",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "28403",
"telephone_number": "910-509-9371",
"fax_number": "910-509-9372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUENTE",
"first_name": "ANTONIO",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-05",
"last_updated": "2015-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NC",
"license": "NC0831",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "04461",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2015; 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.