NPIMap

Organization Active NPI

De Diego Ambulatory Clinic Corp

  • Body Imaging Physician
  • San Juan, PR
National Provider Identifier
1053052852
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
DE DIEGO AMBULATORY CLINIC CORP
Practice address
150 Ave de Diego Ste 1
San Juan, PR 00907-2309
Phone
(787) 977-7575
Fax
(787) 977-7586
NPI assigned
Apr 5, 2022
Last updated
Apr 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Authorized official

Name
Mr. William Jimenez
Title
Billing and Collection Manager
Phone
(787) 977-7575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X NU Primary

Addresses

Primary practice location

150 Ave de Diego Ste 1
San Juan, PR 00907-2309

Mailing address

150 Ave de Diego Ste 1
San Juan, PR 00907-2309
Phone (787) 977-7575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241009000973 PR Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 7315850872 Practice locations: San Juan, PR

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
ASC San Juan Medical Plaza4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

150 Ave de Diego
Ste 1
Santurce, PR 00907
Phone (787) 798-0100

Practitioners & affiliated clinicians

Practitioners 6

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": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1053052852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 AVE DE DIEGO STE 1",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009072309",
            "telephone_number": "787-977-7575",
            "fax_number": "787-977-7586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 AVE DE DIEGO STE 1",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009072309",
            "telephone_number": "787-977-7575",
            "fax_number": "787-977-7586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE DIEGO AMBULATORY CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "BILLING AND COLLECTION MANAGER",
        "authorized_official_telephone_number": "787-977-7575",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.