Mario Luis Olivencia Malave, M.D
Individual provider Active NPI General Practice Physician · Mayaguez, PR
NPI 1770837320 · NPPES record last updated Jul 18, 2017
Key facts
- NPI
- 1770837320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 20164 (PR)
- Practice address
- 55 Calle de Diego E Ste 401
Mayaguez, PR 00680-5081 - Phone
- (787) 487-7866
- NPI assigned
- Nov 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 10
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bella Vista Hospital Inc
Centro de Diagnostico Y Tratamiento de San Sebastian Inc
Practice addresses (Care Compare)
770 Ave Hostos
Mayaguez, PR 00682-1551
Phone (787) 834-6161
Calle Jose Mendez Cardona
San Sebastian, PR 00685-0486
Phone (787) 896-1850
Calle Jose Mendez Cardona No
3 2ND Floor Suite 206
San Sebastian, PR 00685-0486
Phone (787) 896-1850
Hospital & facility affiliations
- Bella Vista Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170727000727 | PR | Practitioner - General Practice | 7315217197 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20164 | PR | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bella Vista Hospital, Inc | Current |
Accepting new patients | |
| Bella Vista Hospital, Inc | Current |
Accepting new patients | |
| Bella Vista Hospital Inc | Past | Accepting new patients | |
| Centro Neumologico del Oeste | Past |
Accepting new patients |
Locations
770 Ave Hostos
#M
Mayaguez, PR 00682
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 20164 | PR | Yes |
Addresses
Primary practice location
55 Calle de Diego E Ste 401
Mayaguez, PR 00680-5081
Mailing address
CPR Profesional Building 65 de Diego E.Suite Ste. 401
Mayaguez, PR 00680-8501
Phone (787) 805-1032
Other providers in Mayaguez, PR
- Abiodun Abayomi Odeleye
- Oficina Dental Dr. Raul F. Cordero C.S.P.
- Oficina Medica Dr. Luis J. Suau, CSP
- Juan Andres Oharriz Vina
- Winston Ojeda-Laracuente
- Antonio R Olivencia-Echeandia
- Humberto N Olivencia
- Joel Hesed Olivencia
- Catherine I. Oliver
- Zolymar Oliveras Texeira
All providers in Mayaguez, PR · General Practice Physician in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.