NPIMap

Organization Active NPI

Instituto de Gastroenterologia de P.R.

  • Gastroenterology Physician
  • San Juan, PR
National Provider Identifier
1942294012
Registry record updated Oct 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
INSTITUTO DE GASTROENTEROLOGIA DE P.R.
Practice address
400 Ave F.D. Roosevelt Ave.
Suite 206
San Juan, PR 00918
Phone
(787) 764-8787
Fax
(787) 250-1029
NPI assigned
Sep 6, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2011

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

Authorized official

Name
Mr. Prudencio A. Laureano, M.H.S.A.
Title
Administrator
Phone
(787) 764-8787

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0100X PR Primary
Gastroenterology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0100X

Addresses

Primary practice location

400 Ave F.D. Roosevelt Ave.
Suite 206
San Juan, PR 00918

Mailing address

400 Ave F.D, Roosevelt Ave.
Suite 206
San Juan, PR 00918
Phone (787) 764-8787

Other names 1

  • Inst Gastroenterologia Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040630000469 PR Part B Supplier - Clinic/Group Practice 4284611096 Receives reassigned benefits from 2 practitioners
Practice locations: San Juan, PR

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Inst Gastroentde P R3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1942294012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AVE F.D, ROOSEVELT AVE.",
            "address_2": "SUITE 206",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00918",
            "telephone_number": "787-764-8787",
            "fax_number": "787-250-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AVE F.D. ROOSEVELT AVE.",
            "address_2": "SUITE 206",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00918",
            "telephone_number": "787-764-8787",
            "fax_number": "787-250-1029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTO DE GASTROENTEROLOGIA DE P.R.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-06",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "LAUREANO",
        "authorized_official_first_name": "PRUDENCIO",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "787-764-8787",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.H.S.A."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PR",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Inst Gastroenterologia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 21, 2011; 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.