NPIMap

Organization Active NPI

Dr Susoni Health Community Services Corp

  • Anesthesiology Physician
  • Arecibo, PR
National Provider Identifier
1053945022
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
DR SUSONI HEALTH COMMUNITY SERVICES CORP
Practice address
Carr, 129 KM 1.0
Ave San Luis
Arecibo, PR 00613-0659
Phone
(787) 650-7272
Fax
(787) 650-7310
NPI assigned
Feb 27, 2020
Organization subpart
Yes
Parent organization
DR SUSONI HEALTH COMMUNITY SERVICES CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Authorized official

Name
Juan L Medina
Title
Billing and Collections Director
Phone
(787) 650-7272

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X

Addresses

Primary practice location

Carr, 129 KM 1.0
Ave San Luis
Arecibo, PR 00613-0659

Mailing address

PO Box 659
Arecibo, PR 00613-0659
Phone (787) 650-7272

Other identifiers 1

IdentifierTypeStateIssuer
400087MedicaidPR

Other names 1

  • Hospital Pavia Arecibo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041207000555 PR Part B Supplier - Clinic/Group Practice 6406828706 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arecibo, PR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Dr Susoni Health Community Services Corp2 organizations share this tax ID, including this one
Part of
Dr Susoni Health Community Services Corp

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1053945022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 659",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006130659",
            "telephone_number": "787-650-7272",
            "fax_number": "787-650-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR, 129 KM 1.0",
            "address_2": "AVE SAN LUIS",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "006130659",
            "telephone_number": "787-650-7272",
            "fax_number": "787-650-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SUSONI HEALTH COMMUNITY SERVICES CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DR SUSONI HEALTH COMMUNITY SERVICES CORP",
        "enumeration_date": "2020-02-27",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING AND COLLECTIONS DIRECTOR",
        "authorized_official_telephone_number": "787-650-7272"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400087",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospital Pavia Arecibo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arecibo, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.