NPIMap

Organization Active NPI

South Renal Care, P.S.C

  • Nephrology Physician
  • Ponce, PR
National Provider Identifier
1295020790
Registry record updated Jun 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
016621 Issued in PR
Legal business name
SOUTH RENAL CARE, P.S.C
Practice address
2275 Ponce by Pass
Caribbean Medical Centre Suite 202
Ponce, PR 00717-1380
Phone
(787) 840-1445
Fax
(787) 848-4657
NPI assigned
Jun 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2011

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

Authorized official

Name
Dr. Luis A Ortiz Heredia, MDNPI 1083810162
Title
President
Phone
(787) 362-0722

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 016621 PR Primary

Addresses

Primary practice location

2275 Ponce by Pass
Caribbean Medical Centre Suite 202
Ponce, PR 00717-1380

Mailing address

PO Box 335251
Ponce, PR 00733-5251
Phone (787) 840-1455

Other identifiers 1

IdentifierTypeStateIssuer
016621OtherPRPR MEDICAL LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120306000794 PR Part B Supplier - Clinic/Group Practice 4688833908 Receives reassigned benefits from 1 practitioner
Practice locations: San Juan, PR; Yauco, PR; Santa Isabel, PR; Ponce, PR; Jayuya, PR; Guayama, PR

National Provider Directory

National Provider Directory

Locations

2275 Ponce Byp
Ste 202
Ponce, PR 00717
Phone (787) 651-3620

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1307923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307923200000",
    "number": "1295020790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 335251",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007335251",
            "telephone_number": "787-840-1455",
            "fax_number": "787-848-4657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 PONCE BY PASS",
            "address_2": "CARIBBEAN MEDICAL CENTRE SUITE 202",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007171380",
            "telephone_number": "787-840-1445",
            "fax_number": "787-848-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH RENAL CARE, P.S.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-13",
        "last_updated": "2011-06-13",
        "status": "A",
        "authorized_official_last_name": "ORTIZ HEREDIA",
        "authorized_official_first_name": "LUIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-362-0722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "PR",
            "license": "016621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PR MEDICAL LICENSE",
            "identifier": "016621",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; 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.