NPIMap

Organization Active NPI

Integrate Community Health System

Doing business as Metro Pavia Clinic Hato Rey Lab

  • Clinical Medical Laboratory
  • San Juan, PR
National Provider Identifier
1205189115
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
INTEGRATE COMMUNITY HEALTH SYSTEM
Doing business as
Metro Pavia Clinic Hato Rey Lab
Practice address
426 Agueybana Street
El Vedado
San Juan, PR 00918-3030
Phone
(787) 772-9850
Fax
(787) 274-8895
NPI assigned
Oct 17, 2012
Last updated
Dec 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Authorized official

Name
Mrs. Vivian Solivan
Title
Director
Phone
(787) 641-4234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

426 Agueybana Street
El Vedado
San Juan, PR 00918-3030

Mailing address

400 Calle Calaf
PMB 455
San Juan, PR 00918-1314
Phone (787) 772-9850

Other names 1

  • Metro Pavia Clinic Hato Rey Lab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160531000139 PR Part B Supplier - Independent Clinical Laboratory 6507760469 3 other NPIs on this enrollment
Practice locations: Aguadilla, PR; Bayamon, PR; Guayama, PR; San Juan, PR

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Integrate Community Health System34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1205189115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 CALLE CALAF",
            "address_2": "PMB 455",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009181314",
            "telephone_number": "787-772-9850",
            "fax_number": "787-274-8895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 AGUEYBANA STREET",
            "address_2": "EL VEDADO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009183030",
            "telephone_number": "787-772-9850",
            "fax_number": "787-274-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATE COMMUNITY HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "SOLIVAN",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "787-641-4234",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metro Pavia Clinic Hato Rey Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Metro Pavia Clinic Hato Rey Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; 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.