Organization Active NPI

Dr. Reynaldo de Jesus Rodriguez PSC

  • Neurological Surgery Physician
  • Ponce, PR
National Provider Identifier
1699068858
Registry record updated May 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
13269 Issued in PR
Legal business name
DR. REYNALDO DE JESUS RODRIGUEZ PSC
Practice address
909 Ave Tito Castro
Torre Medica San Lucas Suite 614
Ponce, PR 00716-4728
Phone
(787) 840-8174
Fax
(787) 843-2084
NPI assigned
May 20, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2011

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

Authorized official

Name
Dr. Reynaldo De Jesus, M.D.
Title
President
Phone
(787) 840-8174

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X 13269 PR Primary

Addresses

Primary practice location

909 Ave Tito Castro
Torre Medica San Lucas Suite 614
Ponce, PR 00716-4728

Mailing address

909 Ave Tito Castro
Torre Medica San Lucas Suite 614
Ponce, PR 00716-4728
Phone (787) 840-8174

Other identifiers 1

IdentifierTypeStateIssuer
1881791663OtherPRNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140521000576 PR Part B Supplier - Clinic/Group Practice 0547483588 Receives reassigned benefits from 1 practitioner
Practice locations: Ponce, PR

National Provider Directory

National Provider Directory

Locations

909 Ave Tito Castro
Ste 614
Ponce, PR 00716
Phone (787) 840-8174

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1305849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305849600000",
    "number": "1699068858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 AVE TITO CASTRO",
            "address_2": "TORRE MEDICA SAN LUCAS SUITE 614",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007164728",
            "telephone_number": "787-840-8174",
            "fax_number": "787-843-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 AVE TITO CASTRO",
            "address_2": "TORRE MEDICA SAN LUCAS SUITE 614",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007164728",
            "telephone_number": "787-840-8174",
            "fax_number": "787-843-2084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. REYNALDO DE JESUS RODRIGUEZ PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-20",
        "last_updated": "2011-05-20",
        "status": "A",
        "authorized_official_last_name": "DE JESUS",
        "authorized_official_first_name": "REYNALDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-840-8174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "PR",
            "license": "13269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1881791663",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.