MD Renal Group LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

17129 Issued in PR

Legal business name

MD RENAL GROUP LLC

Practice address

Avenue Severiano Cuevas 18
Hospital Buen Samaritano Ground Floor
Aguadilla, PR 00605-9026

Phone

(787) 997-0101

NPI assigned

Oct 19, 2011

Organization subpart

No

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

Authorized official

Name

Prof. Mayra I Santiago, M.A.

Title

Administrative Chief Officer

Phone

(939) 639-0557

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MD Renal Group LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ian Jared Da Silva Lugo

  • Nephrology Physician
  • Moca, PR
  • NPI 1184102253

  Single Specialty

  Medicare reassignment NPD
• Jaime J Dasilva Arocho

  • Nephrology Physician
  • Aguadilla, PR
  • NPI 1720062144
  Medicare reassignment NPD

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344902400000",
    "number": "1043595291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 667",
            "city": "MOCA",
            "state": "PR",
            "postal_code": "006760667",
            "telephone_number": "787-997-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "AVENUE SEVERIANO CUEVAS 18",
            "address_2": "HOSPITAL BUEN SAMARITANO GROUND FLOOR",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "006059026",
            "telephone_number": "787-997-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD RENAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-19",
        "last_updated": "2012-08-14",
        "status": "A",
        "authorized_official_last_name": "SANTIAGO",
        "authorized_official_first_name": "MAYRA",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "ADMINISTRATIVE CHIEF OFFICER",
        "authorized_official_telephone_number": "939-639-0557",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "PR",
            "license": "17129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1043595291",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD Renal Group LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Ana Luz Martinez, M.D.
• Hector Martinez, PH.D
• Maritza Martinez, PHD
• Reynaldo Mata Mateo, MD
• Zadhi Y Matias Rosa, MD
• Med Drip Wound Care LLC
• Medica X Siempre
• Medical Health Resources, Corp.
• Medicina Audaz, Inc.
• Medicruz, LLC

• Exclusive Provider Organization in Aguadilla, PR
• Providers in Aguadilla, PR by specialty
• Exclusive Provider Organization in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.