Individual provider Active NPI

Jesus Rene Rivera, MD

  • Emergency Medicine Physician
  • Sunrise, FL
National Provider Identifier
1538148127
Registry record updated Dec 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME65364 Issued in FL
Practice address
1613 Harrison Pkwy
#200
Sunrise, FL 33323-2853
Phone
(954) 838-2371
NPI assigned
Jan 11, 2006
Last updated
Dec 2, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X ME65364 FL Primary

Addresses

Primary practice location

1613 Harrison Pkwy
#200
Sunrise, FL 33323-2853

Mailing address

PO Box 848508
Pembroke Pines, FL 33084-0508

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20051010000579 FL Practitioner - Emergency MedicinePractitioner - Internal Medicine 6406871458 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65364FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Contracting Services LLC Emergency Medicine CurrentSince Nov 1, 2010 Accepting new patients
Inphynet Contracting Services LLC Emergency Medicine Past Accepting new patients
Greater Florida Emergency Group LLC Emergency Medicine Past Accepting new patients
Greater Florida Emergency Group LLC Emergency Medicine Past Accepting new patients

Locations

651 E 25th St
Hialeah, FL 33013
Phone (305) 835-4370

901 45th St
Mangonia Park, FL 33407
Phone (561) 844-6300

5959 NW 7th St
Miami, FL 33126
Phone (305) 264-1000

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259712000000",
    "number": "1538148127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848508",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330840508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 HARRISON PKWY",
            "address_2": "#200",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232853",
            "telephone_number": "954-838-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "JESUS",
        "middle_name": "RENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2009-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME65364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunrise, FL

Sources for this page

Verify at the official NPI Registry.