Kaira Carrasquillo Carrasquillo, M.D.
Individual provider Active NPI General Practice Physician · Carolina, PR
NPI 1124332622 · NPPES record last updated Jul 6, 2023
Key facts
- NPI
- 1124332622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 18272 (PR)
- Practice address
- Carretera 857 KM 9.2 Bo Carruzo
Carolina, PR 00729 - Phone
- (787) 231-1220
- NPI assigned
- Jul 27, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130919000085 | PR | Practitioner - General Practice | 1759525421 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18272 | PR | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physician H.M.O. Inc. | Current |
Accepting new patients | |
| Premium Health Group Clinic | Current |
Accepting new patients | |
| Laguna Gardens Radiology and Imaging Group Inc. | Past | Accepting new patients |
Locations
107 Calle Padre Las Casas
San Juan, PR 00918
Phone (787) 294-7801
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 18272 | PR | Yes |
Addresses
Primary practice location
Carretera 857 KM 9.2 Bo Carruzo
Carolina, PR 00729
Mailing address
PO Box 20000
PMB 351
Canovanas, PR 00729
Phone (787) 750-8241
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38378000 | Medicaid | PR |
Other providers in Carolina, PR
- Carolina OB-GYN
- Carolina Pediatric Group Corp
- Carolina Pediatric Group Corp
- Carolina Sleep & Epilepsy Center
- Carolina Wound & Skin Care LLC
- Jessica M Carrasquillo Miranda
- Luis Carrasquillo
- Nayda Ivette Carrasquillo
- Lizmari Carreras-Rivera
- Juan R Carreras
All providers in Carolina, PR · General Practice Physician in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.