NPIMap

Organization Active NPI

Policlinica Familiar Shalom Inc

  • Emergency Medical Services (Emergency Medicine) Physician
  • Quebradillas, PR
National Provider Identifier
1831302173
Registry record updated Jul 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
145
Legal business name
POLICLINICA FAMILIAR SHALOM INC
Practice address
Bo Terranova Calle Marginal del Parque
Quebradillas, PR 00678
Phone
(787) 895-0914
NPI assigned
May 7, 2007
Last updated
Jul 6, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2017

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

Authorized official

Name
Mr. Ivan Feliciano
Title
Supervisor
Phone
(787) 291-0991

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 145 Primary
General Practice Physician 208D00000X 11789 PR

Addresses

Primary practice location

Bo Terranova Calle Marginal del Parque
Quebradillas, PR 00678

Mailing address

PO Box 903
Quebradillas, PR 00678-0903
Phone (787) 895-0914

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170929001901 PR Part B Supplier - Clinic/Group Practice 8921373093 Receives reassigned benefits from 14 practitioners
2 other NPIs on this enrollment
Practice locations: Quebradillas, PR

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Policlinica Familiar Shalom2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499299200000",
    "number": "1831302173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 903",
            "city": "QUEBRADILLAS",
            "state": "PR",
            "postal_code": "006780903",
            "telephone_number": "787-895-0914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BO TERRANOVA CALLE MARGINAL DEL PARQUE",
            "city": "QUEBRADILLAS",
            "state": "PR",
            "postal_code": "00678",
            "telephone_number": "787-895-0914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLICLINICA FAMILIAR SHALOM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2017-07-06",
        "status": "A",
        "authorized_official_last_name": "FELICIANO",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "787-291-0991",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": "145",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "11789",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quebradillas, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2017; 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.