Ponce Advance Medical Group, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PONCE ADVANCE MEDICAL GROUP, LLC

Practice address

Calle Ferrocarril Munoz Rivera Avenue
Local #4
Ponce, PR 00717-0071

Phone

(787) 813-2325

Fax

(787) 841-3908

NPI assigned

Nov 28, 2022

Organization subpart

No

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

Authorized official

Name

Julia Ortiz Rangel, MD

Title

President

Phone

(787) 843-3089

Specialties & licenses 1

Addresses

Other names 1

• Ponce Advance Medical Group Former legal business name

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Tax ID family

Ponce Advance Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ponce Advance Medical Group

  • Primary Care Clinic/Center
  • Ponce, PR
  • NPI 1104049121
  NPD tax ID

Practitioners 1

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

• Roberto Martir, MD

  • General Practice Physician
  • Mayaguez, PR
  • NPI 1356126262
  NPD (past)

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1346950672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PMB 282",
            "address_2": "1575 MUNOZ RIVERA AVENUE",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "00717",
            "telephone_number": "787-813-2325",
            "fax_number": "787-841-3908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE FERROCARRIL MUNOZ RIVERA AVENUE",
            "address_2": "LOCAL #4",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007170071",
            "telephone_number": "787-813-2325",
            "fax_number": "787-841-3908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONCE ADVANCE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-28",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "ORTIZ RANGEL",
        "authorized_official_first_name": "JULIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-843-3089",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ponce Advance Medical Group",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Ponce Advance Medical Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Daniela Polonio-Mejia
• Ronald Fernando Pomacondor
• Jonathan Pomales Diaz, D.C.
• Ponce Advance Medical Group
• Ponce Advance Medical Group Network, Corp.
• Ponce Area Medical Equipment and Supply Corp
• Ponce Cardiology Group, P. S. C.
• Ponce Cardiovascular Services, PSC
• Ponce Clinical Laboratory, Inc.
• Ponce Clinical Laboratory, Inc.

• All providers in Ponce, PR
• Clinical Medical Laboratory in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; 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.