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SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC
NPI 1891104188
Otolaryngology - Plastic Surgery within the Head & Neck in Ponce, PR

Active since August 12, 2014
TORRE MED SAN LUCAS, AVE. TITO CASTRO, PONCE, PR 00716(787) 290-3333(787) 290-4444 Get Directions Write a Review

NPPES record last updated: August 12, 2014. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Southwest Oto And Head & Neck Surgery,psc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHWEST OTO AND HEAD & NECK SURGERY,PSC (NPI 1891104188) is a healthcare organization registered as a plastic surgery within the head & neck in Ponce, Puerto Rico and active in the NPI registry since August 2014. The organization lists Edgar Domenech Fagundo, Owner, as its authorized official.

NPPES Registry Identity

NPI1891104188
Entity TypeOrganization
Primary Taxonomy207YX0007X
Legal Business NameSOUTHWEST OTO AND HEAD & NECK SURGERY,PSC
Location AddressTORRE MED SAN LUCAS, AVE. TITO CASTROPonce, PR 00716-4728
Mailing AddressPo Box 2000, Pmb 137Mercedita, PR 00715 · (787) 290-3333 · Fax (787) 290-4444
Phone(787) 290-3333
Fax(787) 290-4444
Organization SubpartNo
Authorized OfficialEdgar Domenech FagundoOwner · (787) 290-3333
Enumeration DateAugust 12, 2014
✔ NPI 1891104188 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngology · Plastic Surgery within the Head & NeckAllopathic & Osteopathic Physicians
Taxonomy Code207YX0007X
License✔ Licensed in PR · 13247
Definition
An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.
TORRE MED SAN LUCAS, Ponce, PR 00716
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Other Identifiers 2

Medicare PIN0020400PR
Medicare UPING76827PR

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southwest Oto And Head & Neck Surgery,psc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Southwest Oto And Head & Neck Surgery,psc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Edgar Domenech Fagundo, MD
Otolaryngology
NPI 1386717247
TORRE MEDICA SAN LUCAS, AVE. TITO CASTRO 917 SUITE 618
Ponce, PR 00730
(787) 290-3333
✔ PECOS✔ Accepts Medicare0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southwest Oto And Head & Neck Surgery,psc's NPI number?

The NPI number for Southwest Oto And Head & Neck Surgery,psc is 1891104188. It was assigned to this organization in the NPPES registry on August 12, 2014.

Where is Southwest Oto And Head & Neck Surgery,psc located?

Southwest Oto And Head & Neck Surgery,psc is located at Torre Med San Lucas Ave. Tito Castro, Ponce, PR 00716. The listed phone number is (787) 290-3333.

What is Southwest Oto And Head & Neck Surgery,psc's specialty?

The primary specialty registered for this NPI is Otolaryngology, specializing in Plastic Surgery within the Head & Neck, with taxonomy code 207YX0007X.

Is Southwest Oto And Head & Neck Surgery,psc enrolled in Medicare?

Yes. Southwest Oto And Head & Neck Surgery,psc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southwest Oto And Head & Neck Surgery,psc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Otolaryngology) reassigns their Medicare billing to Southwest Oto And Head & Neck Surgery,psc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Southwest Oto And Head & Neck Surgery,psc was last updated on August 12, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.