NPIMap

Organization Active NPI

Neomed Center, Inc

  • Federally Qualified Health Center (FQHC)
  • San Lorenzo, PR
National Provider Identifier
1124222682
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEOMED CENTER, INC
Practice address
11 Calle Condado
San Lorenzo, PR 00754-4214
Phone
(787) 737-2311
Fax
(787) 737-0244
NPI assigned
Jun 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Dr. Rosa T Castro-Avila, M.D.
Title
Ceo
Phone
(787) 737-2311

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Clinical Medical Laboratory 291U00000X
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

11 Calle Condado
San Lorenzo, PR 00754-4214

Mailing address

PO Box 1277
Gurabo, PR 00778-1277
Phone (787) 737-2311

Other names 1

  • NeoMed Center-OPD San Lorenzo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210914003667 PR Part A Provider - Federally Qualified Health Center (FQHC) 1850284100 Practice locations: San Lorenzo, PR

Federally qualified health center certification: CCN 401865

Legal name
NEOMED CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 14, 2021
Last certification
Sep 14, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 2, 1994 in PR
Enrollment address
11 Calle Condado
San Lorenzo, PR 7544214

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Neomed Center Inc33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Miguel Gonzalez Gonzalez Individual Corporate Director Sep 1, 2010
Jonathan Melendez Avilez Individual W-2 Managing EmployeeCco Jul 7, 2021
Rosa Castro Avila Individual Corporate Director Sep 1, 2010

Practitioners & affiliated clinicians

Practitioners 66

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1124222682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1277",
            "city": "GURABO",
            "state": "PR",
            "postal_code": "007781277",
            "telephone_number": "787-737-2311",
            "fax_number": "787-737-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CALLE CONDADO",
            "city": "SAN LORENZO",
            "state": "PR",
            "postal_code": "007544214",
            "telephone_number": "787-737-2311",
            "fax_number": "787-737-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEOMED CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "CASTRO-AVILA",
        "authorized_official_first_name": "ROSA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "787-737-2311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NeoMed Center-OPD San Lorenzo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Lorenzo, PR

Sources for this page

Verify at the official NPI Registry.