NPIMap

Organization Active NPI

Advance Digital Image, Corp

  • Radiology Clinic/Center
  • San Sebastian, PR
National Provider Identifier
1487735684
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
06171 Issued in PR
Legal business name
ADVANCE DIGITAL IMAGE, CORP
Practice address
Carretara # 111
Interseccion Carr 125 Sears Shoping Center
San Sebastian, PR 00685
Phone
(787) 315-9401
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jose I Rodriguez
Title
Manager
Phone
(787) 315-9401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 06171 PR Primary

Addresses

Primary practice location

Carretara # 111
Interseccion Carr 125 Sears Shoping Center
San Sebastian, PR 00685

Mailing address

PO Box 626
San Sebastian, PR 00685-0626
Phone (787) 315-9401

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070419000460 PR Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8325143399 Practice locations: San Sebastian, PR

National Provider Directory

National Provider Directory

Locations

4598 Ave Arcadio Estrada
Ste 3
San Sebastian, PR 00685
Phone (787) 896-8817

4598 Ave Arcadio Estrada
San Sebastian, PR 00685
Phone (787) 896-8817

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487735684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 626",
            "city": "SAN SEBASTIAN",
            "state": "PR",
            "postal_code": "006850626",
            "telephone_number": "787-315-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARRETARA # 111",
            "address_2": "INTERSECCION CARR 125 SEARS SHOPING CENTER",
            "city": "SAN SEBASTIAN",
            "state": "PR",
            "postal_code": "00685",
            "telephone_number": "787-315-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE DIGITAL IMAGE, CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "787-315-9401"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "PR",
            "license": "06171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Sebastian, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.