Individual provider Active NPI

Nicole Marie Carrillo-Colon, MD

  • Emergency Medicine Physician
  • San Juan, PR
National Provider Identifier
1548989841
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
36948 Issued in PR
Practice address
PO Box 365067
San Juan, PR 00936-5067
Phone
(787) 765-2363
NPI assigned
Aug 22, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 36948 PR Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

PO Box 365067
San Juan, PR 00936-5067

Mailing address

PO Box 365067
San Juan, PR 00936-5067
Phone (787) 757-1800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20260608003866 MI Practitioner - Emergency Medicine 9830660059 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

350 Sentry Pkwy
BLD 660 Suite 102
Blue Bell, PA 19422-2314

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36948PRMDEmergency Medicine Physician

Organizations & group practices 1

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": "1661126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782259200000",
    "number": "1548989841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365067",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009365067",
            "telephone_number": "787-757-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 365067",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009365067",
            "telephone_number": "787-765-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO-COLON",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-22",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PR",
            "license": "36948",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.