Innovative Gastroenterology, PSC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

15354 Issued in PR

Legal business name

INNOVATIVE GASTROENTEROLOGY, PSC

Practice address

A1 Ave Agustin Perez Andino
Villas de Rio Grande
Rio Grande, PR 00745-3000

Phone

(787) 657-8543

Fax

(787) 657-8807

NPI assigned

Jul 1, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Roberto Enrique Mera-Lastra, M.D.NPI 1407812381

Title

President

Phone

(787) 657-8543

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Practitioners 1

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

• Roberto E Mera Lastra, M.D.

  • Gastroenterology Physician
  • Rio Grande, PR
  • NPI 1407812381
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309478400000",
    "number": "1124315809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3017",
            "city": "RIO GRANDE",
            "state": "PR",
            "postal_code": "007453017",
            "telephone_number": "787-657-8543",
            "fax_number": "787-657-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "A1 AVE AGUSTIN PEREZ ANDINO",
            "address_2": "VILLAS DE RIO GRANDE",
            "city": "RIO GRANDE",
            "state": "PR",
            "postal_code": "007453000",
            "telephone_number": "787-657-8543",
            "fax_number": "787-657-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE GASTROENTEROLOGY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-01",
        "last_updated": "2011-07-01",
        "status": "A",
        "authorized_official_last_name": "MERA-LASTRA",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_middle_name": "ENRIQUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-657-8543",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PR",
            "license": "15354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Rio Grande, PR
• Providers in Rio Grande, PR by specialty
• Gastroenterology Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; 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.