Individual provider Active NPI

Carlos A Rivas, MD

  • General Practice Physician
  • Cape Girardeau, MO
National Provider Identifier
1942261052
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
2010011993 Issued in MO
Practice address
3065 William St
Suite 209
Cape Girardeau, MO 63703-6393
Phone
(573) 335-4100
Fax
(573) 339-7887
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X R4668 AR
General Practice Physician 208D00000X 2010011993 MO Primary

Addresses

Primary practice location

3065 William St
Suite 209
Cape Girardeau, MO 63703-6393

Mailing address

3065 William St
Suite 209
Cape Girardeau, MO 63703-6393
Phone (573) 335-4100

Other identifiers 1

IdentifierTypeStateIssuer
1942261052MedicaidMO

Other names 1

  • Carlos A Rivas Ramis Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100609000410 MO Practitioner - Family PracticePractitioner - Emergency Medicine 6507845666 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medstop One IncGroup PAC ID 6800706797, 2 clinicians

Practice addresses (Care Compare)

3065 William St
Cape Girardeau, MO 63703-6373
Phone (573) 335-4100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R4668ARMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Health Center of Stoddard County, LLC Current Accepting new patients
Southeast Health Center of Stoddard County, LLC CurrentSince Aug 1, 2018 Accepting new patients
Medstop One Inc CurrentSince Apr 26, 2018 Accepting new patients
Southeast Health Center of Stoddard County LLC CurrentSince Aug 1, 2018 Accepting new patients
National Emergency Services West Virginia Inc Past Accepting new patients
Logan-Mingo Area Mental Health, Inc Past Accepting new patients
Healthfirst Physicians of Arkansas PA Past Accepting new patients

Locations

3065 William St
Ste 209
Cpe Girardeau, MO 63703
Phone (573) 335-1779

1200 N One Mile Rd
Dexter, MO 63841
Phone (573) 614-1900

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1942261052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3065 WILLIAM ST",
            "address_2": "SUITE 209",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637036393",
            "telephone_number": "573-335-4100",
            "fax_number": "573-339-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3065 WILLIAM ST",
            "address_2": "SUITE 209",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637036393",
            "telephone_number": "573-335-4100",
            "fax_number": "573-339-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVAS",
        "first_name": "CARLOS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AR",
            "license": "R4668",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "2010011993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942261052",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLOS",
            "last_name": "RIVAS RAMIS",
            "middle_name": "A",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.