Individual provider Active NPI

Amanda Yadirah Ortiz Vicil

  • Hepatology Physician
  • Guayama, PR
National Provider Identifier
1720648025
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hepatology PhysicianTaxonomy code 207RI0008X
License
023723 Issued in PR
Practice address
C16 Calle Azucena
Urb Green Hills
Guayama, PR 00784
Phone
(787) 214-3740
NPI assigned
Jun 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hepatology Physician 207RI0008X 023723 PR Primary

Addresses

Primary practice location

C16 Calle Azucena
Urb Green Hills
Guayama, PR 00784

Mailing address

Calle Cesar Gonzalez Condominio Parque de Las Fuentes
Apt 2303
San Juan, PR 00918
Phone (787) 214-3740

Other identifiers 1

IdentifierTypeStateIssuer
6164903OtherPRLICENCE NUMBER

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241212002951 PR Practitioner - Internal Medicine 1951837053 Reassigns benefits to 1 organization
Practice locations: San Juan, PR

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

715 Ave Ponce de Leon
San Juan, PR 00917-5032
Phone (787) 758-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
023723PRMDHepatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Espanol Auxilio Mutuo de Puerto Rico, Inc. CurrentSince Nov 1, 2024 Accepting new patients
Hospital Espanol Auxilio Mutuo de Puerto Rico, Inc. CurrentSince Nov 1, 2024 Accepting new patients
Am Acquisition I, LLC Past Accepting new patients
Departamento de Salud Past Accepting new patients

Locations

715 Ave Ponce de Leon
San Juan, PR 00917
Phone 7877582000 ext. 3216

715 Ave Ponce de Leon
Stop 375
San Juan, PR 00917
Phone 7877582000 ext. 3216

Organizations & group practices 4

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 & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1720648025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CALLE CESAR GONZALEZ CONDOMINIO PARQUE DE LAS FUENTES",
            "address_2": "APT 2303",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00918",
            "telephone_number": "787-214-3740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "C16 CALLE AZUCENA",
            "address_2": "URB GREEN HILLS",
            "city": "GUAYAMA",
            "state": "PR",
            "postal_code": "00784",
            "telephone_number": "787-214-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ VICIL",
        "first_name": "AMANDA",
        "middle_name": "YADIRAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0008X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hepatology",
            "state": "PR",
            "license": "023723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE NUMBER",
            "identifier": "6164903",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Guayama, PR

Sources for this page

Verify at the official NPI Registry.