Individual provider Active NPI

Ilia Noemi Casanova Feliciano, M.D.

  • General Practice Physician
  • Caguas, PR
National Provider Identifier
1497077887
Registry record updated Jun 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
17840 Issued in PR
Practice address
100 Ave Luis Munoz Marin
Caguas, PR 00725-6184
Phone
(787) 653-3434
NPI assigned
Feb 25, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 17840 PR Primary

Addresses

Primary practice location

100 Ave Luis Munoz Marin
Caguas, PR 00725-6184

Mailing address

90 Candelero Dr
Aquabella Palmas del Mar
Humacao, PR 00791
Phone (787) 934-5576

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140708001166 PR Practitioner - General Practice 5799900700 Reassigns benefits to 1 organization
Practice locations: Humacao, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17840PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bella Vista Hospital Inc CurrentSince Aug 12, 2020 Accepting new patients

Locations

100 Ave Luis Munoz Marin
Caguas, PR 00725
Phone (787) 423-2261

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1497077887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 CANDELERO DR",
            "address_2": "AQUABELLA PALMAS DEL MAR",
            "city": "HUMACAO",
            "state": "PR",
            "postal_code": "00791",
            "telephone_number": "787-934-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 AVE LUIS MUNOZ MARIN",
            "city": "CAGUAS",
            "state": "PR",
            "postal_code": "007256184",
            "telephone_number": "787-653-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASANOVA FELICIANO",
        "first_name": "ILIA",
        "middle_name": "NOEMI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-25",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "17840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caguas, PR

Sources for this page

Verify at the official NPI Registry.