NPIMap

Organization Active NPI

Bolanos Surgical Services,C.S.P.

  • Surgical Critical Care Physician
  • Ponce, PR
National Provider Identifier
1548599525
Registry record updated Aug 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
Legal business name
BOLANOS SURGICAL SERVICES,C.S.P.
Practice address
909 Ave Tito Castro
Suite 723 Torre Medica San Lucas
Ponce, PR 00716-4728
Phone
(787) 290-4731
Fax
(787) 259-3355
NPI assigned
Dec 21, 2009
Last updated
Aug 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2014

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

Authorized official

Name
Dr. Guillermo Bolanos-Avila, MD
Title
President
Phone
(787) 290-4731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X Primary

Addresses

Primary practice location

909 Ave Tito Castro
Suite 723 Torre Medica San Lucas
Ponce, PR 00716-4728

Mailing address

1249 Calle Don Quijote
Costa Caribe Golf Villa
Ponce, PR 00716-2022
Phone (787) 290-4731

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100329000485 PR Part B Supplier - Clinic/Group Practice 6204962335 Receives reassigned benefits from 5 practitioners
Practice locations: Ponce, PR

National Provider Directory

National Provider Directory

Locations

909 Ave Tito Castro
#723T
Ponce, PR 00716
Phone (787) 290-4731

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408406400000",
    "number": "1548599525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1249 CALLE DON QUIJOTE",
            "address_2": "COSTA CARIBE GOLF VILLA",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007162022",
            "telephone_number": "787-290-4731",
            "fax_number": "787-259-3355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 AVE TITO CASTRO",
            "address_2": "SUITE 723 TORRE MEDICA SAN LUCAS",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007164728",
            "telephone_number": "787-290-4731",
            "fax_number": "787-259-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLANOS SURGICAL SERVICES,C.S.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-21",
        "last_updated": "2014-08-19",
        "status": "A",
        "authorized_official_last_name": "BOLANOS-AVILA",
        "authorized_official_first_name": "GUILLERMO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-290-4731",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2014; 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.