John E. Rivera Jr., M.D., LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

042567 Issued in CT

Legal business name

JOHN E. RIVERA JR., M.D., LLC

Doing business as

Southington Family Medical Center

Practice address

1753 Meriden-Waterbury Turnpike
Milldale, CT 06467

Phone

(860) 621-5554

Fax

(860) 621-3833

NPI assigned

Feb 27, 2013

Last updated

May 2, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Edwin Rivera Jr., M.D.NPI 1720044811

Title

Owner

Phone

(860) 621-5554

Specialties & licenses 1

Addresses

Other names 1

• Southington Family Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Edwin Rivera Jr., M.D.

  • Family Medicine Physician
  • Milldale, CT
  • NPI 1720044811
  Medicare reassignment NPD Authorized official
• Alyssa A Anderson, APRN

  • Family Nurse Practitioner
  • Branford, CT
  • NPI 1336421171
  Medicare reassignment NPD
• Erin Shaw, APRN

  • Family Nurse Practitioner
  • Middlebury, CT
  • NPI 1477004612
  Medicare reassignment NPD
• William Douglas Farmer, M.D.

  • Internal Medicine Physician
  • Hamden, CT
  • NPI 1689660771
  NPD (past)

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

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367452800000",
    "number": "1902146996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 770",
            "city": "MILLDALE",
            "state": "CT",
            "postal_code": "064670770",
            "telephone_number": "860-621-5554",
            "fax_number": "860-621-3833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1753 MERIDEN-WATERBURY TURNPIKE",
            "city": "MILLDALE",
            "state": "CT",
            "postal_code": "06467",
            "telephone_number": "860-621-5554",
            "fax_number": "860-621-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN E. RIVERA JR., M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-05-02",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-621-5554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "042567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southington Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Milldale, CT
• Providers in Milldale, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2013; 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.