NPIMap

Organization Active NPI

Med Centro, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ponce, PR
National Provider Identifier
1669097374
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MED CENTRO, INC.
Practice address
1046 Ave Hostos
Ponce, PR 00716-1118
Phone
(787) 843-9393
Fax
(787) 841-0077
NPI assigned
Jun 9, 2020
Last updated
Jun 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

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

Authorized official

Name
Mrs. Eneris Marie Medina
Title
Compliance Officer
Phone
(787) 843-9393

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1046 Ave Hostos
Ponce, PR 00716-1118

Mailing address

PO Box 220
Mercedita, PR 00715-0220
Phone (787) 843-9393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031216000213 PR Part B Supplier - Clinic/Group Practice 5890692131 Receives reassigned benefits from 92 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ponce, PR; Villalba, PR; Penuelas, PR; Juana Diaz, PR; Coamo, PR
O20240618002022 PR Part A Provider - Federally Qualified Health Center (FQHC) 5890692131 Practice locations: Ponce, PR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669097374. Details of each certification follow.

Federally qualified health center certification: CCN 401006

Legal name
MED CENTRO INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 13, 2024
Last certification
Jun 13, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 10, 1971 in PR
Enrollment address
1046 Ave Hostos
Ponce, PR 7161118

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Med Centro Inc28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carmen Cruz-Cancel Individual Corporate Director Feb 28, 2018
Allan Cintron-Salichs Individual Corporate Director Mar 16, 2006
W-2 Managing EmployeeExecutive Director Mar 16, 2006
Samuel Santos Rivera Individual Corporate Director Aug 23, 2023
Maria Roque-Torruella Individual Corporate Director Sep 6, 2011
Sol Belfort-Maldonado Individual Corporate Director Sep 26, 2012
Jorge Morales Torres Individual Corporate Director Jan 27, 2021
Jose O Coll-Diaz Individual Corporate Director Aug 28, 2009
Pedro Velez Acosta Individual Corporate Director Feb 26, 2014
Jaime Garcia-Ramirez Individual Corporate Director Jan 1, 2008
Marilyn Santiago Ayala Individual Corporate Director Mar 31, 2021
Gladys Santos-Cintron Individual Corporate Director Jan 1, 1988
Victor Montalvo-Martell Individual Corporate Director Jan 1, 2008
Ileana Yambo Febus Individual Corporate Director Mar 31, 2021
Eduardo Martinez-Tull Individual Corporate Director Jan 1, 2005
Ramberto Rivera Oliveras Individual Corporate DirectorVocal-Board of Directors Apr 24, 2024
Ivan Madera Rodríguez Individual Corporate Director Feb 22, 2023

Practitioners & affiliated clinicians

Practitioners 90

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.

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1669097374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "MERCEDITA",
            "state": "PR",
            "postal_code": "007150220",
            "telephone_number": "787-843-9393",
            "fax_number": "787-841-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1046 AVE HOSTOS",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007161118",
            "telephone_number": "787-843-9393",
            "fax_number": "787-841-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED CENTRO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "ENERIS",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "787-843-9393",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.