NPIMap

Organization Active NPI

Municipio de Isabela

  • Urgent Care Clinic/Center
  • Isabela, PR
National Provider Identifier
1477696805
Registry record updated May 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
MUNICIPIO DE ISABELA
Practice address
Ave. Agustin R Calero
KM 1.1
Isabela, PR 00662
Phone
(787) 830-2705
Fax
(787) 830-0465
NPI assigned
Feb 15, 2007
Organization subpart
Yes
Parent organization
MUNICIPIO DE ISABELAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2018

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

Authorized official

Name
Gisselle K. Van Derdys, MHSA
Title
Administrador
Phone
(787) 830-2705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

Ave. Agustin R Calero
KM 1.1
Isabela, PR 00662

Mailing address

P.O. Box 737
Isabela, PR 00662
Phone (787) 830-2705

Other names 1

  • Centro Isabelino de Medicina Avanzada Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130607000351 PR Part B Supplier - Clinic/Group Practice 8022256759 Receives reassigned benefits from 2 practitioners
Practice locations: Isabela, PR

National Provider Directory

National Provider Directory
Tax ID family
Centro Isabelino de Med Avanzada Cima5 organizations share this tax ID, including this one
Part of
Centro Isabelino de Medicina Avanzada Em

Other organizations with this tax ID 4

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

Locations

7000 Ave Agustin Ramos Calero
Isabela, PR 00662

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525219200000",
    "number": "1477696805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 737",
            "city": "ISABELA",
            "state": "PR",
            "postal_code": "00662",
            "telephone_number": "787-830-2705",
            "fax_number": "787-830-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "AVE. AGUSTIN R CALERO",
            "address_2": "KM 1.1",
            "city": "ISABELA",
            "state": "PR",
            "postal_code": "00662",
            "telephone_number": "787-830-2705",
            "fax_number": "787-830-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNICIPIO DE ISABELA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUNICIPIO DE ISABELA",
        "enumeration_date": "2007-02-15",
        "last_updated": "2018-05-02",
        "status": "A",
        "authorized_official_last_name": "VAN DERDYS",
        "authorized_official_first_name": "GISSELLE",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "ADMINISTRADOR",
        "authorized_official_telephone_number": "787-830-2705",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centro Isabelino de Medicina Avanzada",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Isabela, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2018; 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.