Individual provider Active NPI

Wilson Eddie Torres Santos, PSY. D

  • Clinical Psychologist
  • Ponce, PR
National Provider Identifier
1295220556
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6151 Issued in PR
Practice address
Calle Comercio #96 Local #3
Ponce, PR 00730
Phone
(787) 601-5246
NPI assigned
Jun 28, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 6151 PR Primary

Addresses

Primary practice location

Calle Comercio #96 Local #3
Ponce, PR 00730

Mailing address

Urb. Constancia 2919
Calle Vannina
Ponce, PR 00717
Phone (787) 601-5246

Other identifiers 1

IdentifierTypeStateIssuer
6151OtherPRLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200706000069 PR Practitioner - Clinical Psychologist 3173946472 Practice locations: Ponce, PR

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

96 Calle Comercio
Ponce, PR 00730-5006
Phone (787) 601-5246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1295220556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "URB. CONSTANCIA 2919",
            "address_2": "CALLE VANNINA",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "00717",
            "telephone_number": "787-601-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE COMERCIO #96 LOCAL #3",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "00730",
            "telephone_number": "787-601-5246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TORRES SANTOS",
        "first_name": "WILSON",
        "middle_name": "EDDIE",
        "name_prefix": "Dr.",
        "credential": "PSY. D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-28",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "6151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6151",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.