Samuel Negron Agosto, M.D.
Individual provider Active NPI General Practice Physician · Fajardo, PR
NPI 1164525465 · NPPES record last updated Aug 19, 2016
Key facts
- NPI
- 1164525465
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 11991 (PR)
- Practice address
- Calle Cipres #706 Local #2
Fajardo Gardens
Fajardo, PR 00738 - Phone
- (787) 801-4698
- Fax
- (787) 801-4698
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- PR Healthcare Management Group
Practice addresses (Care Compare)
Carr 31 KM
Suite 0
Naguabo, PR 00718
Phone (787) 874-3152
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 |
|---|---|---|---|---|
| I20041214000100 | PR | Practitioner - General Practice | 5395702187 |
Reassigns benefits to 2 organizations Practice locations: Fajardo, PR |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PR Healthcare Management Group | Current |
Accepting new patients | |
| Puerto Rico Primary Care, Mso, Inc. - Laboratorio | Current |
Accepting new patients | |
| PR Healthcare Management Group | Current |
Accepting new patients | |
| Puerto Rico Primary Care Mso, Inc. - CDT Luquillo | Current |
Accepting new patients |
Locations
159 Calle Quinto Centenario
Luquillo, PR 00773
Phone (787) 500-7752
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 11991 | PR | Yes |
Addresses
Primary practice location
Calle Cipres #706 Local #2
Fajardo Gardens
Fajardo, PR 00738
Mailing address
PO Box 1666
Fajardo, PR 00738-1666
Phone (787) 801-4698
Other providers in Fajardo, PR
- MV Healthcare CSP
- My Optical Factory LLC
- N & G Company Inc
- Nashali Janice Nazario
- Cynthia M Negrin
- Gil A Nieves Alvarez II
- Mariely Nieves Rivera
- Gil Alberto Nieves
- Miguel Angel Figueroa Nieves Sr.
- Niro 2011 LLC
All providers in Fajardo, 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 Aug 19, 2016. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.