Active NPI
Teodorico H. Jaceldo, M.D.
- General Practice Physician
- San Antonio, TX
National Provider Identifier
1821271537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- E5390
- Practice address
- 530 San Pedro
Suite Number 110
San Antonio, TX 78212-5007 - Phone
- (210) 697-5700
- NPI assigned
- Dec 17, 2007
- Last updated
- Dec 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | E5390 | TX | Primary |
Addresses
Primary practice location
530 San Pedro
Suite Number 110
San Antonio, TX 78212-5007
Mailing address
530 San Pedro
Suite Number 110
San Antonio, TX 78212-5007
Phone (210) 697-5700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E5390 | TX | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heritage Health Center | General Practice | Past | Accepting new patients |
| La Paz Community Healthcare Center, Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychiatry Physician
- San Antonio, TX
- NPI 1871776567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1821271537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "530 SAN PEDRO",
"address_2": "SUITE NUMBER 110",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782125007",
"telephone_number": "210-697-5700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 SAN PEDRO",
"address_2": "SUITE NUMBER 110",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782125007",
"telephone_number": "210-697-5700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACELDO",
"first_name": "TEODORICO",
"middle_name": "H.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-17",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "TX",
"license": "E5390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.