Individual provider Active NPI

Richard P Connelly, M.D.

  • General Practice Physician
  • Dorado, PR
National Provider Identifier
1760475644
Registry record updated Jun 1, 2015
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Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
11498 Issued in PR
Practice address
221 Calle Thebe
Paseo del Sol
Dorado, PR 00646-4668
Phone
(787) 278-1985
NPI assigned
Aug 26, 2005
Last updated
Jun 1, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 11498 PR Primary

Addresses

Primary practice location

221 Calle Thebe
Paseo del Sol
Dorado, PR 00646-4668

Mailing address

221 Calle Thebe
Paseo del Sol
Dorado, PR 00646-4668
Phone (787) 278-1985

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
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
I20041208000127 PR Practitioner - General Surgery 4183680408 Practice locations: San Juan, PR

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11498PRMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433116800000",
    "number": "1760475644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 CALLE THEBE",
            "address_2": "PASEO DEL SOL",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "006464668",
            "telephone_number": "787-278-1985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 CALLE THEBE",
            "address_2": "PASEO DEL SOL",
            "city": "DORADO",
            "state": "PR",
            "postal_code": "006464668",
            "telephone_number": "787-278-1985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "RICHARD",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2015-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "11498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dorado, PR

Sources for this page

Verify at the official NPI Registry.