CCK Medical CSP

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

11735 Issued in PR

Legal business name

CCK MEDICAL CSP

Practice address

D3 Frontera Ave Villa Andalucia
San Juan, PUERTO RICO 00926
UM

Phone

(787) 761-1555

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Eddy A Mieses, MD

Title

President

Phone

(787) 761-1555

Specialties & licenses 1

Addresses

Other names 1

• Professional Services Corporation Other name

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

Practitioners 1

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

• Eddy A Mieses Ariza, MD

  • Interventional Cardiology Physician
  • Rios Piedras, PR
  • NPI 1235124587
  Medicare reassignment

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1407931272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270011",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009270011",
            "telephone_number": "787-761-1555",
            "fax_number": "787-292-7260"
        },
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "D3 FRONTERA AVE VILLA ANDALUCIA",
            "city": "SAN JUAN",
            "state": "PUERTO RICO",
            "postal_code": "00926",
            "telephone_number": "787-761-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCK MEDICAL CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "MIESES",
        "authorized_official_first_name": "EDDY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-761-1555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PR",
            "license": "11735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Services Corporation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.