NPIMap

Individual provider Active NPI

Ronald Dela Villareal, MD

  • Nephrology Physician
  • Manhasset, NY
National Provider Identifier
1689859266
Registry record updated Jul 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
263968 Issued in NY
Practice address
1129 Northern Blvd
101
Manhasset, NY 11030-3045
Phone
(516) 365-5570
Fax
(516) 365-5532
NPI assigned
Jan 2, 2008
Last updated
Jul 7, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01071586 IN
Nephrology Physician 207RN0300X 99052287A IN
Nephrology Physician 207RN0300X 263968 NY Primary

Addresses

Primary practice location

1129 Northern Blvd
101
Manhasset, NY 11030-3045

Mailing address

1129 Northern Blvd
Ste. 101
Manhasset, NY 11030-3045
Phone (516) 365-5570

Other identifiers 1

IdentifierTypeStateIssuer
2010864902MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140527000137 NY Practitioner - NephrologyPractitioner - Internal Medicine 8325235799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Heights Nephrology Medical Group PCGroup PAC ID 8729979166, 5 clinicians

Practice addresses (Care Compare)

115 /2 Remsen St
Brooklyn, NY 11201-4212
Phone (718) 852-4949

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01071586INMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heights Nephrology Medical Group, PC Nephrology CurrentSince Jan 5, 2016 Accepting new patients
Pacific Med & Nephrology PastSince Apr 15, 1999 Accepting new patients
Advanced Eyecare, LLC Past Accepting new patients
Nephrology Specialists, PC. Nephrology Past Accepting new patients

Locations

550 Kingston Ave
Brooklyn, NY 11203
Phone (718) 221-5342

340 Henry St
Brooklyn Heights, NY 11201
Phone (718) 780-1469

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1199232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404691200000",
    "number": "1689859266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 NORTHERN BLVD",
            "address_2": "STE. 101",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303045",
            "telephone_number": "516-365-5570",
            "fax_number": "516-365-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 NORTHERN BLVD",
            "address_2": "101",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303045",
            "telephone_number": "516-365-5570",
            "fax_number": "516-365-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLAREAL",
        "first_name": "RONALD",
        "middle_name": "DELA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-02",
        "last_updated": "2014-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01071586",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "99052287A",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "263968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2010864902",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

Verify at the official NPI Registry.