NPIMap

Organization Active NPI

Primary Medical Group, C.S.P.

  • Clinic/Center
  • Ponce, PR
National Provider Identifier
1104216050
Registry record updated Jan 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PRIMARY MEDICAL GROUP, C.S.P.
Practice address
Calle Mendez Vigo #24
Ponce, PR 00733
Phone
(787) 842-0005
Fax
(787) 984-2213
NPI assigned
Jan 30, 2015
Last updated
Jan 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2015

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

Authorized official

Name
Dr. Iraida Del Rio Rodriguez, M.D.
Title
President
Phone
(787) 813-0080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

Calle Mendez Vigo #24
Ponce, PR 00733

Mailing address

PO Box 336149
Ponce, PR 00733-6149
Phone (787) 813-0080

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040626000264 PR Part B Supplier - Clinic/Group Practice 4385556083 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jayuya, PR; Ponce, PR; San Juan, 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
Primary Medical Group CSP4 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

360 Calle del Parque
Ste 5
San Juan, PR 00912
Phone (787) 303-4041

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422576000000",
    "number": "1104216050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 336149",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007336149",
            "telephone_number": "787-813-0080",
            "fax_number": "787-840-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE MENDEZ VIGO #24",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "00733",
            "telephone_number": "787-842-0005",
            "fax_number": "787-984-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY MEDICAL GROUP, C.S.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2015-01-30",
        "status": "A",
        "authorized_official_last_name": "DEL RIO RODRIGUEZ",
        "authorized_official_first_name": "IRAIDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-813-0080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; 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.