Prymed Medical Care, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Ciales, PR
NPI 1881661866 · NPPES record last updated Jan 27, 2016
Key facts
- NPI
- 1881661866
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 36 (PR)
- Legal business name
- PRYMED MEDICAL CARE, INC
- Practice address
- Calle 149 KM 13
Ciales, PR 00638 - Phone
- (787) 871-0601
- Fax
- (787) 871-3960
- NPI assigned
- Mar 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Gladys Rivera
- Title
- Executive Director
- Phone
- (787) 871-0601
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 2
Practitioners 23
-
Eric Alicea Martinez, M.D.
-
Angel Rafael Ayala Sanchez Sr., PSY.D.
-
Antonio Diaz, MD
-
Ubaldo Medina, M.D.
-
Andres F Perez Rodriguez, M.D.
-
Alberto Carlos Serrano, 19316
-
Luis E Tavarez Alarcon, M.D.
-
Ivan Torres Silva, M.D.
-
Sonia Garcia-Esquilin, R.D., L.D.
-
Jorge Gonzalez, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in PR
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
- Corporation · Non-profit
- Incorporated
- Aug 5, 1986 in PR
- Enrollment address
- Road #2 KM 39.8
Bo. Algarrobo
Vega Baja, PR 6941450
Federally qualified health center certification: CCN 401818
- Legal name
- PRYMED MEDICAL CARE INC
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 11, 2012 in PR
- Enrollment address
- Carr 149 KM 13
Ciales, PR 6383601
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Gladys Rivera Estela |
Corporate Director |
Sep 17, 2012 | |
| W-2 Managing Employee |
Sep 17, 2012 | ||
| Corporate Director |
Aug 25, 1997 | 100% | |
| Marisol Vega de Jesus |
Corporate Director |
Jul 1, 1998 | 100% |
| W-2 Managing Employee |
Oct 19, 1989 | 100% | |
| W-2 Managing Employee |
Jul 1, 1998 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041220000012 | PR | Part B Supplier - Clinic/Group Practice | 3870550072 |
Receives reassigned benefits from 21 practitioners 3 other NPIs on this enrollment Practice locations: Ciales, PR; Vega Baja, PR |
| O20121114000641 | PR | Part a Provider - Federally Qualified Health Center (FQHC) | 3870550072 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Vega Baja, PR |
| O20121217000276 | PR | Part a Provider - Federally Qualified Health Center (FQHC) | 3870550072 | Practice locations: Ciales, PR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 36 | PR | Yes |
Addresses
Primary practice location
Calle 149 KM 13
Ciales, PR 00638
Mailing address
PO Box 1427
Ciales, PR 00638-1427
Phone (787) 871-0601
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 401818 | Other | PR | MEDICARE PART A |
| HQ647A | Other | PR | MEDICARE PART A LAB |
Other providers in Ciales, PR
- Pomales Medical Equipment, Inc
- Prymed Medical Care Inc
- Prymed Medical Care Inc
- Prymed Medical Care Inc
- Prymed Medical Care, Inc
- Prymed Salud Mental Ciales
- Ramon Luis Diaz- Rivere
- Oderitza Ramos I
- Rayosx Prymed Medical Care, Inc.
- Rafael David Rios Vega
All providers in Ciales, PR · Federally Qualified Health Center (FQHC) in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.