Active NPI
Pablo Ivan Almodovar, MD
- Dermatology Physician
- San Juan, PR
National Provider Identifier
1124017488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 3519
- Practice address
- 611 Street Pavia
Suite 201
San Juan, PR 00909-2242 - Phone
- (787) 727-5892
- Fax
- (787) 268-3620
- NPI assigned
- Oct 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 3519 | PR | Primary |
Addresses
Primary practice location
611 Street Pavia
Suite 201
San Juan, PR 00909-2242
Mailing address
611 Calle Pavia
Suite 201
San Juan, PR 00909-2242
Phone (787) 727-5892
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94849 | Other | PR | SSS |
| 064979 | Other | PR | LA CRUZ AZUL DE PR (CA) |
| 26193 | Other | PR | MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3519 | PR | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Recinto de Ciencias Medicas | Dermatology | Past | Accepting new patients |
| Recinto de Ciencias Medicas | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Allergy & Immunology Physician
- San Juan, PR
- NPI 1184804361
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209427200000",
"number": "1124017488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "611 CALLE PAVIA",
"address_2": "SUITE 201",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009092242",
"telephone_number": "787-727-5892",
"fax_number": "787-268-3620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 STREET PAVIA",
"address_2": "SUITE 201",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009092242",
"telephone_number": "787-727-5892",
"fax_number": "787-268-3620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALMODOVAR",
"first_name": "PABLO",
"middle_name": "IVAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-19",
"last_updated": "2008-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "PR",
"license": "3519",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SSS",
"identifier": "94849",
"state": "PR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA CRUZ AZUL DE PR (CA)",
"identifier": "064979",
"state": "PR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "26193",
"state": "PR"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.