NPIMap

Organization Active NPI

Modesto S Rivera III MD PA

  • Clinic/Center
  • PRNC Frederck, MD
National Provider Identifier
1922325026
Registry record updated Apr 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
D19963 Issued in MD
Legal business name
MODESTO S RIVERA III MD PA
Practice address
806 Solomons Island Rd N
PRNC Frederck, MD 20678-3919
Phone
(410) 535-3424
Fax
(410) 535-4983
NPI assigned
Apr 28, 2010
Last updated
Apr 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2010

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

Authorized official

Name
Dr. Modesto Santos Rivera III, M.D.NPI 1295821031
Title
President
Phone
(410) 535-4242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X D19963 MD Primary

Addresses

Primary practice location

806 Solomons Island Rd N
PRNC Frederck, MD 20678-3919

Mailing address

806 Solomons Island Rd N
PRNC Frederck, MD 20678-3919
Phone (410) 535-3424

Other identifiers 4

IdentifierTypeStateIssuer
0283OtherGHMSI
1887319 00MedicaidMD
34888001OtherMDBLUE SHIELD CAREFIRST
2122218OtherMAMSI

National Provider Directory

National Provider Directory

Locations

806 Solomons Island Rd N
Prnc Frederck, MD 20678
Phone (410) 535-3424

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1922325026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 SOLOMONS ISLAND RD N",
            "city": "PRNC FREDERCK",
            "state": "MD",
            "postal_code": "206783919",
            "telephone_number": "410-535-3424",
            "fax_number": "410-535-4983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 SOLOMONS ISLAND RD N",
            "city": "PRNC FREDERCK",
            "state": "MD",
            "postal_code": "206783919",
            "telephone_number": "410-535-3424",
            "fax_number": "410-535-4983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO S RIVERA III MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "MODESTO",
        "authorized_official_middle_name": "SANTOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-535-4242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MD",
            "license": "D19963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHMSI",
            "identifier": "0283",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1887319 00",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CAREFIRST",
            "identifier": "34888001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "2122218",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.