San Juan Primary Health Care Providers, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SAN JUAN PRIMARY HEALTH CARE PROVIDERS, LLC

Practice address

Carretera 844 KM 4.2 Bo. Cupey Bajo
San Juan, PR 00926

Phone

(787) 760-0770

NPI assigned

Sep 12, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Santiago Eli Medina-Mangual, M.D.

Title

Owner

Phone

(787) 760-0770

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Santiago Eli Medina

  • General Practice Physician
  • San Juan, PR
  • NPI 1881845782
  Medicare reassignment
• Elizabeth J. Iglesias Fulbright, PHD

  • Clinical Psychologist
  • San Juan, PR
  • NPI 1669620241
  NPD (past)

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454544000000",
    "number": "1235411711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "LE 93 VIA PARIS L'ANTIGUA",
            "city": "TRUJILLO ALTO",
            "state": "PR",
            "postal_code": "00976",
            "telephone_number": "787-760-0770",
            "fax_number": "787-760-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARRETERA 844 KM 4.2 BO. CUPEY BAJO",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00926",
            "telephone_number": "787-760-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN PRIMARY HEALTH CARE PROVIDERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2016-02-04",
        "status": "A",
        "authorized_official_last_name": "MEDINA-MANGUAL",
        "authorized_official_first_name": "SANTIAGO",
        "authorized_official_middle_name": "ELI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-760-0770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Juan Nephrology P.S.C.
• San Juan Ophthalmology Group CSP
• San Juan Pediatric Dental Home PSC
• San Juan Pelvic Medicine Center, P.S.C.
• San Juan Periodontics
• San Juan Smile Spa, LLC
• San Juan Uscg Clinic
• San Juan Vamc
• San Juan Vamc
• San Juan Vamc

• Primary Care Clinic/Center in San Juan, PR
• Providers in San Juan, PR by specialty
• Primary Care Clinic/Center in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; 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.