NPIMap

Organization Active NPI

De Diego Ambulatory Clinic Corp

Doing business as ASC San Juan Medical Plaza

  • Ambulatory Surgical Clinic/Center
  • San Juan, PR
National Provider Identifier
1407813181
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
30 Issued in PR
Legal business name
DE DIEGO AMBULATORY CLINIC CORP
Doing business as
ASC San Juan Medical Plaza
Practice address
150 Ave de Diego
Condominio San Juan Health Centre Box 1
San Juan, PR 00907-2300
Phone
(787) 977-7575
Fax
(787) 977-7605
NPI assigned
Apr 27, 2006
Last updated
Jun 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Authorized official

Name
Dr. Jorge Colon, M.D.
Title
Medical Director
Phone
(787) 977-7575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 30 PR Primary

Addresses

Primary practice location

150 Ave de Diego
Condominio San Juan Health Centre Box 1
San Juan, PR 00907-2300

Mailing address

150 Ave de Diego
Condominio San Juan Health Centre Box 1
San Juan, PR 00907-2300
Phone (787) 977-7575

Other names 1

  • ASC San Juan Medical Plaza Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000891 PR Part B Supplier - Ambulatory Surgical Center 7315850872 Practice locations: San Juan, PR

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
De Diego Ambulatory Clinic CorpCCN 40C0001022
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
ASC San Juan Medical Plaza4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1407813181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 AVE DE DIEGO",
            "address_2": "CONDOMINIO SAN JUAN HEALTH CENTRE BOX 1",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009072300",
            "telephone_number": "787-977-7575",
            "fax_number": "787-977-7605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 AVE DE DIEGO",
            "address_2": "CONDOMINIO SAN JUAN HEALTH CENTRE BOX 1",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009072300",
            "telephone_number": "787-977-7575",
            "fax_number": "787-977-7605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE DIEGO AMBULATORY CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "COLON",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "787-977-7575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PR",
            "license": "30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASC San Juan Medical Plaza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.