NPIMap

Organization Active NPI

Canovanas Medical Center CSP

  • Emergency Care Clinic/Center
  • Canovanas, PR
National Provider Identifier
1710354899
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Care Clinic/CenterTaxonomy code 261QE0002X
Legal business name
CANOVANAS MEDICAL CENTER CSP
Practice address
Calle Corchado Final
Canovanas, PR 00729
Phone
(787) 876-5000
Fax
(787) 957-0761
NPI assigned
Aug 25, 2015
Last updated
Jul 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Dr. Carlos R Mellado, DOCTORNPI 1104847268
Title
President
Phone
(787) 876-5000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Care Clinic/Center 261QE0002X Primary

Addresses

Primary practice location

Calle Corchado Final
Canovanas, PR 00729

Mailing address

PO Box 2003
Canovanas, PUERTO RICO 00729
UM
Phone (787) 876-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211013003701 PR Part B Supplier - Clinic/Group Practice 8022416502 Receives reassigned benefits from 5 practitioners
Practice locations: Canovanas, PR

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, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1710354899",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "PO BOX 2003",
            "city": "CANOVANAS",
            "state": "PUERTO RICO",
            "postal_code": "00729",
            "telephone_number": "787-876-5000",
            "fax_number": "787-957-0761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE CORCHADO FINAL",
            "city": "CANOVANAS",
            "state": "PR",
            "postal_code": "00729",
            "telephone_number": "787-876-5000",
            "fax_number": "787-957-0761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANOVANAS MEDICAL CENTER CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "MELLADO",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-876-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DOCTOR"
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canovanas, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2021; 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.