NPIMap

Organization Active NPI

Southern Obstetrics and Gynecologic Center, P.S.C.

  • Obstetrics Physician
  • Juana Diaz, PR
National Provider Identifier
1114206315
Registry record updated Sep 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics PhysicianTaxonomy code 207VX0000X
License
17318 Issued in PR
Legal business name
SOUTHERN OBSTETRICS AND GYNECOLOGIC CENTER, P.S.C.
Practice address
Calle Carrion Maduro
Num 29
Juana Diaz, PR 00795-0000
Phone
(787) 837-6419
Fax
(787) 260-4859
NPI assigned
Aug 5, 2011
Last updated
Sep 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2016

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

Authorized official

Name
Dr. Roberto Burgos-Rodriguez, M.D.NPI 1427246776
Title
President
Phone
(787) 308-8547

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics Physician 207VX0000X 17318 PR Primary

Addresses

Primary practice location

Calle Carrion Maduro
Num 29
Juana Diaz, PR 00795-0000

Mailing address

F-89 Calle Reina Isabel
Mansiones Paseo de Reyes
Juana Diaz, PR 00795-4010
Phone (787) 837-6419

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110913000668 PR Part B Supplier - Clinic/Group Practice 2961673462 Receives reassigned benefits from 2 practitioners
Practice locations: Juana Diaz, PR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473206400000",
    "number": "1114206315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "F-89 CALLE REINA ISABEL",
            "address_2": "MANSIONES PASEO DE REYES",
            "city": "JUANA DIAZ",
            "state": "PR",
            "postal_code": "007954010",
            "telephone_number": "787-837-6419",
            "fax_number": "787-260-4859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE CARRION MADURO",
            "address_2": "NUM 29",
            "city": "JUANA DIAZ",
            "state": "PR",
            "postal_code": "007950000",
            "telephone_number": "787-837-6419",
            "fax_number": "787-260-4859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OBSTETRICS AND GYNECOLOGIC CENTER, P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2016-09-07",
        "status": "A",
        "authorized_official_last_name": "BURGOS-RODRIGUEZ",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-308-8547",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "PR",
            "license": "17318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Juana Diaz, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; 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.