Individual provider Active NPI

Pablo A Gomez Cortes

  • Land Ambulance
  • Aguadilla, PR
National Provider Identifier
1851506265
Registry record updated Oct 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
TC-AMB-411 Issued in PR
Practice address
Carr 467 KM 4.4
Barrio Camaseyes
Aguadilla, PR 00603-1503
Phone
(787) 617-9110
Fax
(787) 890-0724
NPI assigned
May 11, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X TC-AMB-411 PR Primary

Addresses

Primary practice location

Carr 467 KM 4.4
Barrio Camaseyes
Aguadilla, PR 00603-1503

Mailing address

137 Calle Harrison
Aguadilla, PR 00603-1503
Phone (787) 617-9110

Other identifiers 1

IdentifierTypeStateIssuer
660670738OtherPRIRS TAX ID #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060911000024 PR Part B Supplier - Ambulance Service Supplier 3072517853 Practice locations: Aguadilla, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
TC-AMB-411PRMDLand Ambulance

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381795200000",
    "number": "1851506265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 CALLE HARRISON",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "006031503",
            "telephone_number": "787-617-9110",
            "fax_number": "787-890-0724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARR 467 KM 4.4",
            "address_2": "BARRIO CAMASEYES",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "006031503",
            "telephone_number": "787-617-9110",
            "fax_number": "787-890-0724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ CORTES",
        "first_name": "PABLO",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2013-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PR",
            "license": "TC-AMB-411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS TAX ID #",
            "identifier": "660670738",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aguadilla, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; 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.