Luis Ivan Rosa Benique, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

22852 Issued in PR

Practice address

Bo Naranjo Carr 417 R 4415 KM 3.6
Aguada, PR 00602

Phone

(939) 288-8145

NPI assigned

Oct 25, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Mediko Medicina Primaria Corp

  • Primary Care Clinic/Center
  • Caguas, PR
  • NPI 1609096981
  Medicare reassignment NPD

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

{
    "created_epoch": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1669015319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HC- 56 BOX 46772",
            "city": "AGUADA",
            "state": "PR",
            "postal_code": "00602",
            "telephone_number": "939-288-8145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BO NARANJO CARR 417 R 4415 KM 3.6",
            "city": "AGUADA",
            "state": "PR",
            "postal_code": "00602",
            "telephone_number": "939-288-8145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Bo Naranjo Car 417 R 4415",
            "address_purpose": "LOCATION",
            "city": "Aguada",
            "state": "PR",
            "postal_code": "00602",
            "country_code": "US",
            "telephone_number": "939-288-8145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSA BENIQUE",
        "first_name": "LUIS",
        "middle_name": "IVAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-25",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "22852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jorge Orlando Roman Vale, MD
• Hilda Roman Valle
• Alicebel Roman, PHARM D
• Brunilda Roman
• Doris I Romero Lopez, M.A.
• Santiago Rosa, M.D
• Coralysmarie Rosado Cortes, LMT
• Paola Rosado Rodriguez, DMD
• Manuel Enrique Rosario Manzano, PA
• Rosario Medical Transport

• General Practice Physician in Aguada, PR
• Providers in Aguada, PR by specialty
• General Practice Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.