NPIMap

Organization Active NPI

Caribe Physicians Plaza Corporation

Doing business as Hospital Caribbean Medical Center

  • General Acute Care Hospital
  • Fajardo, PR
National Provider Identifier
1215051404
Registry record updated Sep 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
18 Issued in PR
Legal business name
CARIBE PHYSICIANS PLAZA CORPORATION
Doing business as
Hospital Caribbean Medical Center
Practice address
151 Ave Osvaldo Molina
Fajardo, PR 00738-4013
Phone
(787) 801-0081
Fax
(787) 801-0086
NPI assigned
Mar 16, 2007
Last updated
Sep 15, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2009

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

Authorized official

Name
Mr. Miguel Jose Bustelo, MHSA
Title
Administrator
Phone
(787) 801-0081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 18 PR Primary

Addresses

Primary practice location

151 Ave Osvaldo Molina
Fajardo, PR 00738-4013

Mailing address

PO Box 70006
Fajardo, PR 00738-7006
Phone (787) 801-0081

Other names 1

  • Hospital Caribbean Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050713001119 PR Part B Supplier - Clinic/Group Practice 0042246712 Receives reassigned benefits from 34 practitioners
Practice locations: Ceiba, PR; Fajardo, PR; Rio Grande, PR
O20091208000272 PR Part A Provider - Hospital 0042246712 Practice locations: Fajardo, PR; Rio Grande, PR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215051404. Details of each certification follow.

Hospital certification: CCN 400131

Legal name
CARIBE PHYSICIANS PLAZA CORPORATION
Doing business as
CARIBBEAN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Nov 16, 2010
Last certification
Sep 30, 2010
Beds
25
Ownership / control type
Private (for profit)
Organization structure
CorporationProprietary
Incorporated
Apr 1, 1997 in PR
Enrollment address
151 Ave Osvaldo Molina
Fajardo, PR 7384013
Main/Primary Hospital Location
Hospital subgroups
General

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Caribbean Medical CenterCCN 400131 · All quality measures
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Centro de Diagnostico Y Tratamiento Ceiba Medical Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Caribe Physicians Plaza Corporation Organization, Fajardo, PR Corporation 5% Or Greater Direct Ownership Interest Apr 1, 1997 100%
Laboratorio Clinico Y Referencia de Fajardo Inc Organization, Fajardo, PR Corporation 5% Or Greater Direct Ownership Interest Aug 31, 2006 13.4%
Sara Lopez Martin Individual 5% Or Greater Indirect Ownership InterestExecutive Director Oct 6, 2000 39.93%
Diana Fernandez Garcia Individual 5% Or Greater Indirect Ownership Interest Oct 6, 2000 10.48%
Ana Oliveras Laguna Individual Corporate OfficerAdministrator May 2, 2016
Luis Torres Individual W-2 Managing EmployeeFinance Director Aug 1, 2017

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Centro Medico del NoresteFajardo, PR, CCN 400141 Hospital 5% Or Greater Direct Ownership Interest (33.28%) Oct 25, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 44

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 44

Affiliated clinicians 32

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1215051404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70006",
            "city": "FAJARDO",
            "state": "PR",
            "postal_code": "007387006",
            "telephone_number": "787-801-0081",
            "fax_number": "787-801-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 AVE OSVALDO MOLINA",
            "city": "FAJARDO",
            "state": "PR",
            "postal_code": "007384013",
            "telephone_number": "787-801-0081",
            "fax_number": "787-801-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARIBE PHYSICIANS PLAZA CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2009-09-15",
        "status": "A",
        "authorized_official_last_name": "BUSTELO",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "JOSE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "787-801-0081",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "PR",
            "license": "18",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospital Caribbean Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fajardo, PR

Sources for this page

Verify at the official NPI Registry.