Premier Nuclear Medicine CSP

Primary specialty

Nuclear Imaging & Therapy PhysicianTaxonomy code 207UN0902X

License

10641 Issued in PR

Legal business name

PREMIER NUCLEAR MEDICINE CSP

Practice address

Hospital Ryder Memorial
355 Calle Font Martelo
Humacao, PR 00791-3249

Phone

(787) 850-2012

Fax

(787) 850-2012

NPI assigned

Sep 19, 2011

Organization subpart

No

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

Authorized official

Name

Maria E Acevedo, MD

Title

President

Phone

(787) 402-0100

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1316390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1295017010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "URBANIZACION SANTA ROSA",
            "address_2": "CALLE 9 BLQ 17 NO 17",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009596606",
            "telephone_number": "787-402-0100",
            "fax_number": "787-294-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HOSPITAL RYDER MEMORIAL",
            "address_2": "355 CALLE FONT MARTELO",
            "city": "HUMACAO",
            "state": "PR",
            "postal_code": "007913249",
            "telephone_number": "787-850-2012",
            "fax_number": "787-850-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER NUCLEAR MEDICINE CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-19",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "ACEVEDO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-402-0100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207UN0902X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": "PR",
            "license": "10641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "FC340A",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nuclear Medicine Physician in Humacao, PR
• Providers in Humacao, PR by specialty
• Nuclear Medicine Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.