NPIMap

Organization Active NPI

Departamento de Salud Oficial

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Juan, PR
National Provider Identifier
1881746923
Registry record updated Sep 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
33 Issued in PR
Legal business name
DEPARTAMENTO DE SALUD OFICIAL
Practice address
Hospital Universitario de Adultos
Medical Center
San Juan, PR 00922-2116
Phone
(787) 754-0101
Fax
(787) 294-3609
NPI assigned
Jan 17, 2007
Last updated
Sep 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2012

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

Authorized official

Name
Jorge E Matta Sr., MHSA
Title
Executive Director
Phone
(787) 754-0101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 33 PR Primary

Addresses

Primary practice location

Hospital Universitario de Adultos
Medical Center
San Juan, PR 00922-2116

Mailing address

Hospital Universitario Adultos Tercer Piso
Medical Center
San Juan, PR 00922-2116
Phone (787) 754-0101

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121002000794 PR Part A Provider - End-Stage Renal Disease Facility (ESRD) 9537170162 Practice locations: San Juan, PR

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Centro de Diagnostico Y Tratamiento Yabucoa67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348531200000",
    "number": "1881746923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HOSPITAL UNIVERSITARIO ADULTOS TERCER PISO",
            "address_2": "MEDICAL CENTER",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009222116",
            "telephone_number": "787-754-0101",
            "fax_number": "787-294-3609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HOSPITAL UNIVERSITARIO DE ADULTOS",
            "address_2": "MEDICAL CENTER",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009222116",
            "telephone_number": "787-754-0101",
            "fax_number": "787-294-3609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTAMENTO DE SALUD OFICIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2012-09-25",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "787-754-0101",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "PR",
            "license": "33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; 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.