Individual provider Active NPI

Bernadette Montes-Carrillo, MD-GENERAL PRACTICE

  • General Practice Physician
  • San Juan, PR
National Provider Identifier
1124203955
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
16976 Issued in PR
Practice address
30 Ave Teresa Jornet Suite 114
Galeria Pacifico
San Juan, PR 00926
Phone
(787) 665-0450
NPI assigned
Dec 28, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 16976 PR Primary

Addresses

Primary practice location

30 Ave Teresa Jornet Suite 114
Galeria Pacifico
San Juan, PR 00926

Mailing address

224 Calle Tropical
Urb. Montehiedra
San Juan, PR 00926
Phone (787) 312-5554

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080821000253 PR Practitioner - General Practice 5890860191 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Integrate Community Health System CurrentSince Aug 1, 2019 Accepting new patients
Metro Pavia Healthcare Center General Practice CurrentSince Feb 21, 2019 Accepting new patients
Integrate Community Health System, Inc. CurrentSince Aug 1, 2019 Accepting new patients
Metro Pavia Healthcare Centers Inc Current Accepting new patients
Metro Pavia Healthcare Center CurrentSince Feb 21, 2019 Accepting new patients
Integrate Community Health System Current Accepting new patients
Hyde Park Medical Group PSC Past Accepting new patients
Atencion Medica Inmediata Past Accepting new patients

Locations

D10 Calle 2
Bayamon, PR 00957

426 Calle Agueybana
San Juan, PR 00918
Phone (787) 238-5801

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1124203955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 CALLE TROPICAL",
            "address_2": "URB. MONTEHIEDRA",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-312-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 AVE TERESA JORNET SUITE 114",
            "address_2": "GALERIA PACIFICO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-665-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTES-CARRILLO",
        "first_name": "BERNADETTE",
        "name_prefix": "Mrs.",
        "credential": "MD-GENERAL PRACTICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-28",
        "last_updated": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "16976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.