NPIMap

Organization Active NPI

Prymed Medical Care, Inc

  • Multi-Specialty Clinic/Center
  • Vega Baja, PR
National Provider Identifier
1841605417
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PRYMED MEDICAL CARE, INC
Practice address
Road #2 KM. 39.8
Bo. Algarrobo
Vega Baja, PR 00693
Phone
(787) 871-0601
Fax
(787) 871-3960
NPI assigned
Jun 23, 2014
Last updated
Jun 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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

Authorized official

Name
Mrs. Gladys Rivera
Title
Executive Director
Phone
(787) 871-0601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

Road #2 KM. 39.8
Bo. Algarrobo
Vega Baja, PR 00693

Mailing address

Road 149 KM 12.3
Ciales
Ciales, PR 00638-1427
Phone (787) 424-5454

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121114000641 PR Part A Provider - Federally Qualified Health Center (FQHC) 3870550072 1 other NPI on this enrollment
Practice locations: Vega Baja, PR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841605417. Details of each certification follow.

Federally qualified health center certification: CCN 401819

Legal name
PRYMED MEDICAL CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 15, 2012
Last certification
Nov 15, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 5, 1986 in PR
Enrollment address
Road #2 KM 39.8
Bo. Algarrobo
Vega Baja, PR 6941450

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Ctro Serv Primarios Lab12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Gladys Rivera Estela Individual Corporate DirectorExecutive Director Sep 17, 2012
W-2 Managing EmployeeExecutive Director Sep 17, 2012
Marisol Vega de Jesus Individual Corporate DirectorFinance Director Jul 1, 1998 100%
W-2 Managing EmployeeFinance Director Oct 19, 1989 100%

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530144000000",
    "number": "1841605417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ROAD 149 KM 12.3",
            "address_2": "CIALES",
            "city": "CIALES",
            "state": "PR",
            "postal_code": "006381427",
            "telephone_number": "787-424-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROAD #2 KM. 39.8",
            "address_2": "BO. ALGARROBO",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "00693",
            "telephone_number": "787-871-0601",
            "fax_number": "787-871-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRYMED MEDICAL CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2018-06-28",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "GLADYS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "787-871-0601",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vega Baja, PR

Sources for this page

Verify at the official NPI Registry.