NPIMap

Organization Active NPI

Prymed Medical Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Ciales, PR
National Provider Identifier
1881661866
Registry record updated Jan 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
36 Issued in 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
Last updated
Jan 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2016

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
Federally Qualified Health Center (FQHC) 261QF0400X 36 PR Primary

Addresses

Primary practice location

Calle 149 KM 13
Ciales, PR 00638

Mailing address

PO Box 1427
Ciales, PR 00638-1427
Phone (787) 871-0601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1881661866. 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

Federally qualified health center certification: CCN 401818

Legal name
PRYMED MEDICAL CARE INC
Organization structure
CorporationNon-profit
Incorporated
Oct 11, 2012 in PR
Enrollment address
Carr 149 KM 13
Ciales, PR 6383601

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 4

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

National Provider Directory

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
Corporate DirectorExecutive Director Aug 25, 1997 100%
Marisol Vega de Jesus Individual Corporate DirectorFinance Director Jul 1, 1998 100%
W-2 Managing EmployeeFinance Director Oct 19, 1989 100%
W-2 Managing EmployeeFinance Director Jul 1, 1998 100%

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453852800000",
    "number": "1881661866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1427",
            "city": "CIALES",
            "state": "PR",
            "postal_code": "006381427",
            "telephone_number": "787-871-0601",
            "fax_number": "787-871-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE 149 KM 13",
            "city": "CIALES",
            "state": "PR",
            "postal_code": "00638",
            "telephone_number": "787-871-0601",
            "fax_number": "787-871-3960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRYMED MEDICAL CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2016-01-27",
        "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PR",
            "license": "36",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ciales, PR

Sources for this page

Verify at the official NPI Registry.