NPIMap

Organization Active NPI

Policlinica Familiar Shalom Inc

  • Public Health & General Preventive Medicine Physician
  • Mayaguez, PR
National Provider Identifier
1619580321
Registry record updated Aug 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
Legal business name
POLICLINICA FAMILIAR SHALOM INC
Practice address
25 Calle Mendez Vigo W
Mayaguez, PR 00680-6756
Phone
(787) 896-1850
Fax
(787) 280-9497
NPI assigned
Aug 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2020

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

Authorized official

Name
Vivian Feliciano Nieves
Title
Executive Director
Phone
(787) 896-1850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X Primary

Addresses

Primary practice location

25 Calle Mendez Vigo W
Mayaguez, PR 00680-6756

Mailing address

PO Box 903
Quebradillas, PR 00678-0903
Phone (787) 896-1850

Other names 1

  • SERVICIOS PREVENTIVOS DE SALUD DE MAYAGUEZ PUERTO RICO Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170929001901 PR Part B Supplier - Clinic/Group Practice 8921373093 Receives reassigned benefits from 14 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quebradillas, PR

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1619580321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 903",
            "city": "QUEBRADILLAS",
            "state": "PR",
            "postal_code": "006780903",
            "telephone_number": "787-896-1850",
            "fax_number": "787-280-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CALLE MENDEZ VIGO W",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "006806756",
            "telephone_number": "787-896-1850",
            "fax_number": "787-280-9497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLICLINICA FAMILIAR SHALOM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-24",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "FELICIANO NIEVES",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "787-896-1850"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SERVICIOS PREVENTIVOS DE SALUD DE MAYAGUEZ PUERTO RICO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mayaguez, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.