NPIMap

Organization Active NPI

CDT Dr. Enrique Koppish

  • State or Local Public Health Clinic/Center
  • San Juan, PR
National Provider Identifier
1811101686
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
CDT DR. ENRIQUE KOPPISH
Practice address
404 Ave Barbosa Esq Calle Sicilia Rio Piedras
San Juan, PR 00924
Phone
(787) 480-3586
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Authorized official

Name
Mrs. Angeliz Rodriguez, LIC
Title
Administrator
Phone
(787) 480-3586

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X Primary

Addresses

Primary practice location

404 Ave Barbosa Esq Calle Sicilia Rio Piedras
San Juan, PR 00924

Mailing address

PO Box 21405
San Juan, PR 00928-1405
Phone (787) 480-3876

Other identifiers 16

IdentifierTypeStateIssuer
030364OtherPRCRUZ AZL
9230049OtherPRHUMANA TODOS
=========OtherPRCIGNA EXCLUSIVE
=========OtherPRMAPHRE HEALTH MED ADV
6604270EKMedicaidPR
=========OtherPRAMERICAN HEALTH
=========OtherPRCIGNA PREFERRED
1138OtherPRPROSAM
=========MedicaidPR
6604270EKOtherPRCOSVI PRIVADO
700031OtherPRMMM
=========OtherPRMCS LIFE
N875OtherPRFIRST MEDICAL
1001051OtherPRACCA
=========OtherPRPAN AMERICAN
=========OtherPRGOLDEN CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109000215 PR Part A Provider - Hospital 5597711945 15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Juan, PR

Hospital certification: CCN 400015

Legal name
MUNICIPALITY OF SAN JUAN PR
Doing business as
SAN JUAN MUNICIPALITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 1, 2023
Beds
450
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
Bo Monacillos Centro Medico Rio Piedras
San Juan, PR 926
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

Care Compare: Hospital

Medicare Care Compare
Listed as
San Juan Municipality HospitalCCN 400015
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
CDT Dr a J Garcia63 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

404 Ave Barbosa
San Juan, PR 00917
Phone (787) 480-3560

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Luis V Clas Individual Corporate Officer Jan 11, 2021
Corporate Director Jan 11, 2021
W-2 Managing Employee Jan 11, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Luis V Clas, M.D.
    • Emergency Medicine Physician
    • San Juan, PR
    • NPI 1497733349

    Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Affiliated clinicians 20

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1811101686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21405",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009281405",
            "telephone_number": "787-480-3876",
            "fax_number": "787-758-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 AVE BARBOSA ESQ CALLE SICILIA RIO PIEDRAS",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00924",
            "telephone_number": "787-480-3586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CDT DR. ENRIQUE KOPPISH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "ANGELIZ",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "787-480-3586",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LIC"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRUZ AZL",
            "identifier": "030364",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA TODOS",
            "identifier": "9230049",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA EXCLUSIVE",
            "identifier": "=========",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAPHRE HEALTH MED ADV",
            "identifier": "=========",
            "state": "PR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604270EK",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN HEALTH",
            "identifier": "=========",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PREFERRED",
            "identifier": "=========",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROSAM",
            "identifier": "1138",
            "state": "PR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "=========",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COSVI PRIVADO",
            "identifier": "6604270EK",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MMM",
            "identifier": "700031",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCS LIFE",
            "identifier": "=========",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST MEDICAL",
            "identifier": "N875",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACCA",
            "identifier": "1001051",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAN AMERICAN",
            "identifier": "=========",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GOLDEN CROSS",
            "identifier": "=========",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.