Active NPI
Ricardo Diaz, DDS, MS
- Periodontics
- San Antonio, TX
National Provider Identifier
1538259254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 14488
- Practice address
- 4871 Fredericksburg Rd
San Antonio, TX 78229 - Phone
- (210) 349-5553
- Fax
- (210) 349-5844
- NPI assigned
- Oct 13, 2006
- Last updated
- Feb 23, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 14488 | TX | Primary |
Addresses
Primary practice location
4871 Fredericksburg Rd
San Antonio, TX 78229
Mailing address
4871 Fredericksburg Rd
San Antonio, TX 78229
Phone (210) 349-5553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150827000259 | TX | Order and Referring Only - Other (Physician) | 2062728645 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14488 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TX Southern Dental PPO PC | Periodontics | 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, 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": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235347200000",
"number": "1538259254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4871 FREDERICKSBURG RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78229",
"telephone_number": "210-349-5553",
"fax_number": "210-349-5844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4871 FREDERICKSBURG RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78229",
"telephone_number": "210-349-5553",
"fax_number": "210-349-5844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "RICARDO",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2009-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "14488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.