NPIMap

Organization Active NPI

Puerto Rico Primary Care Mso, Inc. - CDT Luquillo

  • Emergency Care Clinic/Center
  • Luquillo, PR
National Provider Identifier
1134873235
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Care Clinic/CenterTaxonomy code 261QE0002X
Legal business name
PUERTO RICO PRIMARY CARE MSO, INC. - CDT LUQUILLO
Practice address
Calle 14 de Julio No 159
Bo Mata de Platano
Luquillo, PR 00773
Phone
(787) 885-4446
Fax
(787) 885-6129
NPI assigned
Feb 8, 2022
Last updated
Feb 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
Keila Centeno
Title
Administrator
Phone
(787) 534-3789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Care Clinic/Center 261QE0002X Primary

Addresses

Primary practice location

Calle 14 de Julio No 159
Bo Mata de Platano
Luquillo, PR 00773

Mailing address

PO Box 818
Ceiba, PR 00735-0818
Phone (787) 534-3789

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230925002483 PR Part B Supplier - Clinic/Group Practice 3274987268 Receives reassigned benefits from 19 practitioners
2 other NPIs on this enrollment
Practice locations: Luquillo, PR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Luquillo- Opd4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

159 Calle Quinto Centenario
Luquillo, PR 00773
Phone (787) 500-7752

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1134873235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 818",
            "city": "CEIBA",
            "state": "PR",
            "postal_code": "007350818",
            "telephone_number": "787-534-3789",
            "fax_number": "787-885-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE 14 DE JULIO NO 159",
            "address_2": "BO MATA DE PLATANO",
            "city": "LUQUILLO",
            "state": "PR",
            "postal_code": "00773",
            "telephone_number": "787-885-4446",
            "fax_number": "787-885-6129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUERTO RICO PRIMARY CARE MSO, INC. - CDT LUQUILLO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-08",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "CENTENO",
        "authorized_official_first_name": "KEILA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "787-534-3789"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Luquillo, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; 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.