Individual provider Active NPI

Mariely Nicole Ortiz, DMD

  • General Practice Dentistry
  • Patillas, PR
National Provider Identifier
1760861769
Registry record updated Apr 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3252 Issued in PR
Practice address
Calle Guillermo Rieskohl
Patillas, PR 00723-0697
Phone
(787) 839-4320
NPI assigned
May 22, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3252 PR Primary

Addresses

Primary practice location

Calle Guillermo Rieskohl
Patillas, PR 00723-0697

Mailing address

Ext Villa Milagros
46 Rene Alfonso
Yauco, PR 00698
Phone (787) 202-8826

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190916000364 PR Practitioner - Dentist 1557690609 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3252PRMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Servicios Primarios de Salud de Patillas Inc. CurrentSince Aug 26, 2019 Accepting new patients
Centro Servicios Primarios de Salud de Patillas Inc. CurrentSince Aug 26, 2019 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mariely.ortiz@cspsp.directbygreenway.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554249600000",
    "number": "1760861769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "EXT VILLA MILAGROS",
            "address_2": "46 RENE ALFONSO",
            "city": "YAUCO",
            "state": "PR",
            "postal_code": "00698",
            "telephone_number": "787-202-8826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE GUILLERMO RIESKOHL",
            "city": "PATILLAS",
            "state": "PR",
            "postal_code": "007230697",
            "telephone_number": "787-839-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ",
        "first_name": "MARIELY",
        "middle_name": "NICOLE",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-22",
        "last_updated": "2019-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "3252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Patillas, PR

Sources for this page

Verify at the official NPI Registry.