Individual provider Active NPI

Jaime Hernan Rivera, M.D.

  • Pediatrics Physician
  • Poughkeepsie, NY
National Provider Identifier
1811057193
Registry record updated Mar 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
131829 Issued in NY
Practice address
104 Fulton Ave
Poughkeepsie, NY 12603-2808
Phone
(845) 452-1700
NPI assigned
Dec 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 131829 NY
Pediatrics Physician 208000000X C1-0002870 DE
Pediatrics Physician 208000000X 131829 NY Primary

Addresses

Primary practice location

104 Fulton Ave
Poughkeepsie, NY 12603-2808

Mailing address

104 Fulton Ave
Poughkeepsie, NY 12603-2808
Phone (845) 452-1700

Other identifiers 2

IdentifierTypeStateIssuer
0000028901MedicaidDE
00249707MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20110228000718 NY Practitioner - General PracticePractitioner - Pediatric Medicine 7810178522 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C1-0002870DEMDPediatrics Physician
131829NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physician Services of New York, P.C. Emergency Medicine CurrentSince Apr 1, 2019 Accepting new patients
Essen Medical Urgicare, PLLC CurrentSince Apr 3, 2018 Accepting new patients
Essen Medical Associates, PC CurrentSince Mar 1, 2018 Accepting new patients
Essen Medical Associates, PC Current Accepting new patients
Essen Medical Associates,PC CurrentSince Mar 1, 2018 Accepting new patients
Betances Health Center Past Accepting new patients
Betances Health Center Past Accepting new patients

Locations

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

1550 Dr Martin L King Jr Blvd
Bronx, NY 10452
Phone (347) 269-2366

8989 Union Tpke
Glendale, NY 11385
Phone (718) 480-6207

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

45 Reade Pl
Poughkeepsie, NY 12601
Phone (845) 331-3131

Organizations & group practices 7

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": "1165622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1811057193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 FULTON AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032808",
            "telephone_number": "845-452-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 FULTON AVE",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126032808",
            "telephone_number": "845-452-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "JAIME",
        "middle_name": "HERNAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-09",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "131829",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "DE",
            "license": "C1-0002870",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "131829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000028901",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00249707",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Poughkeepsie, NY

Sources for this page

Verify at the official NPI Registry.