NPIMap

Organization Active NPI

Modern Radiology, PSC

  • Diagnostic Radiology Physician
  • San Juan, PR
National Provider Identifier
1750645107
Registry record updated Jun 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
RX4816 Issued in PR
Legal business name
MODERN RADIOLOGY, PSC
Practice address
300 Ave Felisa Rincon
72 Vistas Shopping Village
San Juan, PR 00926-6088
Phone
(787) 709-4337
NPI assigned
Jun 30, 2012
Last updated
Jun 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2012

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

Authorized official

Name
Dr. Gamalier Bermudez Ruiz, MD
Title
President
Phone
(787) 848-8834

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X RX4816 PR Primary

Addresses

Primary practice location

300 Ave Felisa Rincon
72 Vistas Shopping Village
San Juan, PR 00926-6088

Mailing address

P O Box 7346
Ponce, PR 00732-7346
Phone (787) 709-4337

Other identifiers 2

IdentifierTypeStateIssuer
RX4816OtherPRPROVIDER LICENSE NUMBER
1306804752OtherPRNPI

National Provider Directory

National Provider Directory
Tax ID family
Modern Radiology PSC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1341014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341014400000",
    "number": "1750645107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 7346",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007327346",
            "telephone_number": "787-709-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 AVE FELISA RINCON",
            "address_2": "72 VISTAS SHOPPING VILLAGE",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009266088",
            "telephone_number": "787-709-4337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN RADIOLOGY, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-30",
        "last_updated": "2012-06-30",
        "status": "A",
        "authorized_official_last_name": "BERMUDEZ RUIZ",
        "authorized_official_first_name": "GAMALIER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-848-8834",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PR",
            "license": "RX4816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER LICENSE NUMBER",
            "identifier": "RX4816",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1306804752",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.