NPIMap

Individual provider Active NPI

Luis Alberto Medina Aviles, MD

  • Family Medicine Physician
  • Arecibo, PR
National Provider Identifier
1124174214
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12097 Issued in PR
Practice address
Carr. 638 KM 0.1
Domingo Ruiz
Arecibo, PR 00616
Phone
(787) 815-3239
Fax
(787) 650-9884
NPI assigned
Jan 25, 2007
Last updated
Nov 26, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12097 PR Primary

Addresses

Primary practice location

Carr. 638 KM 0.1
Domingo Ruiz
Arecibo, PR 00616

Mailing address

HC 2 Box 6870
Bajadero, PR 00616-9771
Phone (787) 815-3239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040206000532 PR Practitioner - Family Practice 0648163162 Practice locations: Arecibo, PR

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Carr 638 KM
1 Bo Domingo Ruiz
Arecibo, PR 00612-9999
Phone (787) 815-3239

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles Medical Health Clinic Family Medicine Past Accepting new patients
La Vida Medical Group Hatillo Corp Family Medicine Past Accepting new patients
Hospital Dr. Susoni. Inc. Past Accepting new patients
Instituto Medico del Norte Inc Past Accepting new patients
La Vida Medical Group Hatillo Corp Past Accepting new patients
Centro de Medicina Familiar Y Control de Dolor Family Medicine Past Accepting new patients
Los Angeles Medical Clinic Corp Family Medicine Past Accepting new patients
Dr Susoni Health Community Services Corp Past Accepting new patients

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1124174214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HC 2 BOX 6870",
            "city": "BAJADERO",
            "state": "PR",
            "postal_code": "006169771",
            "telephone_number": "787-815-3239",
            "fax_number": "787-650-9884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR. 638 KM 0.1",
            "address_2": "DOMINGO RUIZ",
            "city": "ARECIBO",
            "state": "PR",
            "postal_code": "00616",
            "telephone_number": "787-815-3239",
            "fax_number": "787-650-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA AVILES",
        "first_name": "LUIS",
        "middle_name": "ALBERTO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PR",
            "license": "12097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arecibo, PR

Sources for this page

Verify at the official NPI Registry.