NPIMap

Organization Active NPI

Centro de Servicios Primarios de Salud Inc

  • Federally Qualified Health Center (FQHC)
  • Florida, PR
National Provider Identifier
1104896190
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRO DE SERVICIOS PRIMARIOS DE SALUD INC
Practice address
3 Antonio Alcazar St
Florida, PR 00650-0368
Phone
(787) 822-2170
Fax
(787) 822-7026
NPI assigned
Jan 24, 2006
Last updated
Apr 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Authorized official

Name
Mrs. Rosa Agostini Vargas
Title
Executive Director
Phone
(787) 822-2170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3 Antonio Alcazar St
Florida, PR 00650-0368

Mailing address

3 Antonio Alcazar St
PO Box 368
Florida, PR 00650-0368
Phone (787) 822-2170

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101222001007 PR Part B Supplier - Clinic/Group Practice 1456549005 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Florida, PR
O20191016000062 PR Part A Provider - Federally Qualified Health Center (FQHC) 1456549005 Practice locations: Florida, PR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104896190. Details of each certification follow.

Federally qualified health center certification: CCN 401860

Legal name
CENTRO DE SERVICIOS PRIMARIOS DE SALUD INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2019
Last certification
Oct 17, 2019
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 16, 1987 in PR
Enrollment address
Calle Antonio Alcazar #3
Florida, PR 6501912

Other NPIs with the same Medicare PAC ID 1

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

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
Lab Clin Ctro SVC Primari6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Juan Rivera Vega Individual Corporate DirectorMember Board of Directors Jun 1, 2019
Norberto Serrano Maldonado Individual Corporate DirectorMember Board of Director Mar 1, 2015
Maria Aria Soto Individual Corporate DirectorMember Board of Directors Sep 1, 2013
Doris Gonzalez Rios Individual Corporate DirectorSecretary Board of Directors Dec 1, 1992
Elba Quiles Individual W-2 Managing EmployeeOficial de Reures Hureanes Sep 20, 2019
Olga Santiago Serrano Individual Corporate DirectorMember Board of Director Dec 1, 1992
Edwin Perez Vazquez Individual Corporate DirectorVP Board of Directors Mar 1, 2006
Rosa Agostini Individual Corporate DirectorExecutive Director Feb 1, 1992
W-2 Managing EmployeeExecutive Director Feb 1, 1992
Yvette Roman Rodriguez Individual Corporate DirectorPresident Board of Directors Dec 1, 1992
Jorge Reina Castellano Individual Corporate DirectorTreasurer Board of Directors Jun 1, 2006
Maria Martinez Individual 5% Or Greater Direct Ownership Interest Jul 31, 2024 5%

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": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1104896190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ANTONIO ALCAZAR ST",
            "address_2": "PO BOX 368",
            "city": "FLORIDA",
            "state": "PR",
            "postal_code": "006500368",
            "telephone_number": "787-822-2170",
            "fax_number": "787-822-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ANTONIO ALCAZAR ST",
            "city": "FLORIDA",
            "state": "PR",
            "postal_code": "006500368",
            "telephone_number": "787-822-2170",
            "fax_number": "787-822-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SERVICIOS PRIMARIOS DE SALUD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "AGOSTINI VARGAS",
        "authorized_official_first_name": "ROSA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "787-822-2170",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florida, PR

Sources for this page

Verify at the official NPI Registry.