Vidalus LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

VIDALUS LLC

Practice address

677 Calle Felipe Gutierrez
San Juan, PR 00924-2207

Phone

(561) 578-1730

NPI assigned

Aug 4, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Mark C Blackburn

Title

Manager

Phone

(561) 578-1730

Specialties & licenses 1

Addresses

Other names 1

• Vidalus LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

Practitioners 1

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

• Nayraliz Colon-Nieves, M.D.

  • General Practice Physician
  • Caguas, PR
  • NPI 1013148097
  Medicare reassignment NPD

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1699402255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 HARBOUR LIGHTS DR",
            "city": "HUMACAO",
            "state": "PR",
            "postal_code": "007916055",
            "telephone_number": "561-578-1730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CALLE FELIPE GUTIERREZ",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009242207",
            "telephone_number": "561-578-1730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDALUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-04",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "561-578-1730",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vidalus LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Juan Sebastian Vidal-Santiago, MD
• Aracelis Vidal
• Carlos Alfonso Vidal, M.D.
• Ramon E Vidal, MD
• Sergio Andres Vidal
• Vidasana Family Practice LLC
• Liza Viejo
• Laura Melissa Viel Torres
• Sara Viel Torres, DIETICIAN
• Marie Amir Viel

• Clinic/Center in San Juan, PR
• Providers in San Juan, PR by specialty
• Clinic/Center in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; 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.