Edwin Emmanuel Mendez – Emergency Medicine Physician

Key facts

NPI: 1639788474
Entity type: Individual (NPI type 1)
Primary specialty: Emergency Medicine Physician 207P00000X
License: 23496 (PR)
Practice address: 550 Calle Concepcion Vera
Moca, PR 00676-5005
Phone: (787) 877-8000
NPI assigned: Jul 28, 2020
Sex: Male
Sole proprietor: No

Organizations & group practices 3

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.

Hospital San Carlos Incorporado Rural Acute Care Hospital · Moca, PR · NPI 1104856889

Medicare reassignment NPD PR
Servicios Hospitalistas San Carlos Borromeo Hospitalist Physician · Moca, PR · NPI 1891467429

NPD
Servicios de Anestesia Hospital San Carlos Borromeo Anesthesiology Physician · Moca, PR · NPI 1780286542

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in PR
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20240711001749	PR	Practitioner - Emergency Medicine	2668917915	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Status	New patients
Hospital San Carlos Incorporado	Current since May 28, 2024	Accepting new patients
Servicios Hospitalistas San Carlos Borromeo	Current since May 28, 2024	Accepting new patients
Servicios de Anestesia Hospital San Carlos Borromeo	Past since Nov 22, 2020	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Emergency Medicine Physician	207P00000X	23496	PR	Yes

Addresses

Primary practice location

550 Calle Concepcion Vera
Moca, PR 00676-5005

Mailing address

PO Box 1174
Moca, PR 00676-1174
Phone (939) 276-3183

Other practice location 1

Carr 111 INT 420 KM 1.6
Voladoras
Moca, PR 00676-0067
Phone (787) 939-2763

Other names

Edwin Emmanuel Mendez Former name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 14, 2024.

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1639788474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1174",
            "city": "MOCA",
            "state": "PR",
            "postal_code": "006761174",
            "telephone_number": "939-276-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 CALLE CONCEPCION VERA",
            "city": "MOCA",
            "state": "PR",
            "postal_code": "006765005",
            "telephone_number": "787-877-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Carr 111 INT 420 KM 1.6",
            "address_2": "Voladoras",
            "address_purpose": "LOCATION",
            "city": "Moca",
            "state": "PR",
            "postal_code": "006760067",
            "country_code": "US",
            "telephone_number": "787-939-2763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDEZ",
        "first_name": "EDWIN",
        "middle_name": "EMMANUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-28",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PR",
            "license": "23496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDWIN",
            "last_name": "MENDEZ",
            "middle_name": "EMMANUEL",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Moca, PR

All providers in Moca, PR · Emergency Medicine Physician in Puerto Rico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.