Elite Medical Clinic of PR LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ELITE MEDICAL CLINIC OF PR LLC

Practice address

400 Ave Domenech Ste 412
Las Americas Professional Center
San Juan, PR 00918-3748

Phone

(787) 945-0767

NPI assigned

Feb 11, 2020

Organization subpart

No

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

Authorized official

Name

Yadira Dominguez Vazquez, MDNPI 1003288143

Title

President

Phone

(787) 239-7575

Specialties & licenses 1

Addresses

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.

• Yadira Dominguez Vazquez, M.D.

  • General Practice Physician
  • Bayamon, PR
  • NPI 1003288143

  General Practice, PR

  Medicare reassignment NPD Authorized official
• Hector Casas Jr., M.D.

  • General Practice Physician
  • Bayamon, PR
  • NPI 1255703351

  General Practice, PR

  Medicare reassignment NPD

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

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1093347692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AVE DOMENECH STE 412",
            "address_2": "LAS AMERICAS PROFESSIONAL CENTER",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009183748",
            "telephone_number": "787-945-0767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AVE DOMENECH STE 412",
            "address_2": "LAS AMERICAS PROFESSIONAL CENTER",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009183748",
            "telephone_number": "787-945-0767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MEDICAL CLINIC OF PR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-11",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ VAZQUEZ",
        "authorized_official_first_name": "YADIRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-239-7575",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliel Ortho Medical Corp
• Elite Care Services, Inc.
• Elite Chiropractic & Wellness LLC
• Elite Chiropractic Healing Clinics
• Elite Endodontics
• Elite Medical Global Puerto Rico, LLC
• Elite Network Physicians Home Services PSC
• Elite OB-GYN
• Elite Periodontics
• Juliette Siham Elmusa Rivera, LND

• All providers in San Juan, PR
• General Practice Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.