Med Centro, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Ponce, PR
NPI 1295727147 · NPPES record last updated Sep 5, 2024
Key facts
- NPI
- 1295727147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MED CENTRO, INC.
- Practice address
- 1034 Ave Hostos
Ponce, PR 00716-1115 - Phone
- (787) 843-9393
- Fax
- (787) 841-0077
- NPI assigned
- Aug 17, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Allan Cintron-Salichs, MBA, MHCM
- Title
- Executive Director
- Phone
- (787) 843-9393
Other NPIs on the same Medicare enrollment 19
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 26
Practitioners 107
-
Angelis Alvarado, MD
-
Antonio Radames Alvarez, M.D.
-
Javier Alexis Caraballo, M.D.
-
Alex J Cedeno Rodriguez, M.D.
-
Alexander Cedeno, PSY. D.
-
Francisco Colon-Rivera, M.D.
-
Vanessa Cortes Torres, M.D.
-
Monica Cruz, PSY.D.
-
Nydia Garcia, MD
-
Francisco Gomez Goytia, M.D.
-
Lizbette Justiniano, M. D.
-
Felix Maldonado, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in PR
Federally qualified health center certification: CCN 401822
- Legal name
- MED CENTRO INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 10, 2014
- Last certification
- Nov 10, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 4, 1971 in PR
- Enrollment address
- 1034 Ave Hostos
Ponce, PR 7161115
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Carmen Cruz-Cancel |
Corporate Director |
Feb 28, 2018 | |
| Allan Cintron-Salichs |
Corporate Director |
Mar 16, 2006 | 100% |
| W-2 Managing Employee |
Mar 16, 2006 | 100% | |
| Samuel Santos Rivera |
Corporate Director |
Aug 23, 2023 | |
| Maria Roque-Torruella |
Corporate Director |
Sep 6, 2011 | |
| Sol Belfort-Maldonado |
Corporate Director |
Sep 26, 2012 | |
| Jorge Morales Torres |
Corporate Director |
Jan 27, 2021 | |
| Jose O Coll-Diaz |
Corporate Director |
Jan 1, 2011 | |
| Pedro Velez Acosta |
Corporate Director |
Feb 26, 2014 | |
| Jaime Garcia-Ramirez |
Corporate Director |
Jan 1, 2008 | |
| Marilyn Santiago Ayala |
Corporate Director |
Mar 31, 2021 | |
| Gladys Santos-Cintron |
Corporate Director |
Jan 1, 1988 | |
| Victor Montalvo-Martell |
Corporate Director |
Jan 1, 2008 | |
| Ileana Yambo Febus |
Corporate Director |
Mar 31, 2021 | |
| Eduardo Martinez-Tull |
Corporate Director |
Jan 1, 2005 | |
| Ramberto Rivera Oliveras |
Corporate Director |
Apr 24, 2024 | |
| Ivan Madera Rodríguez |
Corporate Director |
Feb 22, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031216000213 | PR | Part B Supplier - Clinic/Group Practice | 5890692131 |
Receives reassigned benefits from 92 practitioners 16 other NPIs on this enrollment Practice locations: Ponce, PR; Villalba, PR; Penuelas, PR; Juana Diaz, PR; Coamo, PR |
| O20050625000025 | PR | Part B Supplier - Independent Clinical Laboratory | 5890692131 |
2 other NPIs on this enrollment Practice locations: Penuelas, PR; Ponce, PR |
| O20051102000919 | PR | Part B Supplier - Clinic/Group Practice | 5890692131 |
Receives reassigned benefits from 24 practitioners 3 other NPIs on this enrollment Practice locations: Penuelas, PR; Ponce, PR |
| O20111004000177 | PR | Part B Supplier - Ambulatory Surgical Center | 5890692131 |
Receives reassigned benefits from 15 practitioners 1 other NPI on this enrollment Practice locations: Ponce, PR |
| O20141110000133 | PR | Part a Provider - Federally Qualified Health Center (FQHC) | 5890692131 | Practice locations: Ponce, PR |
National Provider Directory
- Tax ID family
- Med Centro Inc
Locations
1046 Ave Hostos
Ponce, PR 00716
Phone (787) 842-0170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist |
133N00000X | |||
| Clinic/Center | 261Q00000X | |||
| Dental Clinic/Center | 261QD0000X | |||
| Emergency Care Clinic/Center | 261QE0002X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Mammography Clinic/Center | 261QR0206X | |||
| Urgent Care Clinic/Center | 261QU0200X | |||
| Clinical Medical Laboratory | 291U00000X |
Addresses
Primary practice location
1034 Ave Hostos
Ponce, PR 00716-1115
Mailing address
PO Box 220
Mercedita, PR 00715-0220
Phone (787) 843-9393
Other practice location 1
Carr. 149 Km 57.7 Villalba Arriba
Villalba, PR 00766-3402
Phone (787) 843-9393
Other practice location 2
138 Luis Munoz Marin Ave.
Coamo, PR 00769-0000
Phone (787) 843-9393
Other practice location 3
Carr.1 Km 135.5 Bo. Capitanejo Sector Singapur
Juana Diaz, PR 00795-0000
Phone (787) 843-9393
Other practice location 4
Carr. 385 Km 6.5 Bo. Cuebas
Penuelas, PR 00624-7501
Phone (787) 843-9393
Other practice location 5
Calle H N-9 Nueva Vida El Tuque
Ponce, PR 00728-6725
Phone (787) 843-9393
Other practice location 6
1046 Ave Hostos
Ponce, PR 00716-1118
Phone (787) 843-9393
Other practice location 7
72 Calle Mayor
Ponce, PR 00730-3724
Phone (787) 843-9393
Other names
- Consejo de Salud de Puerto Rico, Inc.
Other providers in Ponce, PR
- Med Centro Inc.
- Med Centro Inc.
- Med Centro, Inc.
- Med Centro, Inc.
- Med Centro, Inc.
- Med Centro, Inc.
- Med Centro, Inc.
- Med Centro, Inc.
- Med Centro, Inc.
- Med Centro, Inc.
All providers in Ponce, PR · Federally Qualified Health Center (FQHC) in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.