Individual provider Active NPI

Manuel Enrique Vazquez, MD

  • General Practice Physician
  • Canovanas, PR
National Provider Identifier
1861486144
Registry record updated Aug 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
14671 Issued in PR
Practice address
Calle Bahuinia, Z978 Local a,
Loiza Valley
Canovanas, PR 00729
Phone
(787) 256-2853
Fax
(787) 257-0995
NPI assigned
Sep 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Emergency Response Attendant 146D00000X 14671 PR
Legal Medicine 173000000X 14671 PR
General Practice Physician 208D00000X 14671 PR Primary

Addresses

Primary practice location

Calle Bahuinia, Z978 Local a,
Loiza Valley
Canovanas, PR 00729

Mailing address

72 Calle Gardenia
Urb.Ciudad Jardin
Carolina, PR 00987-2206
Phone (787) 750-1843

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040204000487 PR Practitioner - General Practice 0840183869 Reassigns benefits to 2 organizations
Practice locations: Canovanas, PR

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gemi PSCGroup PAC ID 0345568820, 9 clinicians

Practice addresses (Care Compare)

B41 Calle Elliot Velez
Manati, PR 00674-4615
Phone (787) 621-4364

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
14671PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gemipsc CurrentSince Mar 18, 2024 Accepting new patients
Metro Pavia Healthcare Centers Inc CurrentSince Dec 12, 2018 Accepting new patients
Metro Pavia Healthcare Center CurrentSince Dec 12, 2018 Accepting new patients
Metro Pavia Healthcare Centers Inc Current Accepting new patients
National Medical Centers Inc General Practice Past Accepting new patients
Centro Especializado de Medicina Integrada Past Accepting new patients

Locations

B41 Calle Elliot Velez
Manati, PR 00674
Phone (787) 621-4364

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470787200000",
    "number": "1861486144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 CALLE GARDENIA",
            "address_2": "URB.CIUDAD JARDIN",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009872206",
            "telephone_number": "787-750-1843",
            "fax_number": "787-257-0995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE BAHUINIA, Z978 LOCAL A,",
            "address_2": "LOIZA VALLEY",
            "city": "CANOVANAS",
            "state": "PR",
            "postal_code": "00729",
            "telephone_number": "787-256-2853",
            "fax_number": "787-257-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZQUEZ",
        "first_name": "MANUEL",
        "middle_name": "ENRIQUE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2016-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "PR",
            "license": "14671",
            "primary": false
        },
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "PR",
            "license": "14671",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "14671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canovanas, PR

Sources for this page

Verify at the official NPI Registry.