Active NPI
Gudalia Fajardo
- Family Nurse Practitioner
- Port Huron, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4704267837
- Practice address
- 2603 Electric Ave Ste 1
Port Huron, MI 48060-6588 - Phone
- (810) 987-5252
- Fax
- (810) 987-2120
- NPI assigned
- Nov 4, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704267837 | MI | Primary |
Addresses
Primary practice location
2603 Electric Ave Ste 1
Port Huron, MI 48060-6588
Mailing address
45640 Schoenherr Rd
Suite B
Utica, MI 48315-6033
Phone (586) 247-4300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141224001070 | MI | Practitioner - Nurse Practitioner | 6709109713 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Clair Specialty Physicians PC
Practice addresses (Care Compare)
23857 Greenfield Rd
Southfield, MI 48075-3122
Phone (248) 569-6111
2603 Electric Ave
Suite D
Port Huron, MI 48060-6588
Phone (810) 987-5252
3559 Pine St
Deckerville, MI 48427-7703
Phone (810) 376-2835
Hospital & facility affiliations
- Lake Huron Medical Center
- McLaren Port Huron
- McKenzie Health System
- Deckerville Community Hospital
- Harbor Beach Community Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Clair Specialty Physicians PC | Current | Accepting new patients | |
| Idaho Nephrology Associates, L.L.C | Past | Accepting new patients | |
| Colorado Springs Nephrology | Past | Accepting new patients |
Locations
3559 Pine St
Deckerville, MI 48427
Phone (810) 376-2835
2603 Electric Ave
Ste 1
Port Huron, MI 48060
Phone (810) 824-4198
2603 Electric Ave
Ste D
Port Huron, MI 48060
Phone (810) 987-5252
23857 Greenfield Rd
Southfield, MI 48075
Phone (248) 569-6111
45640 Schoenherr Rd
Ste B
Utica, MI 48315
Phone (586) 247-4300
Interoperability endpoints
- rosariofajardo@stclairspe.allscriptsdirect.net
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Nephrology Physician
- Colorado Springs, CO
- NPI 1376879254
-
- Nephrology Physician
- Boise, ID
- NPI 1598789950
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Family Medicine Physician
- Deckerville, MI
- NPI 1164818977
Hospital
-
- Critical Access Hospital
- Harbor Beach, MI
- NPI 1124089743
Hospital
-
- Pulmonary Disease Physician
- Harbor Beach, MI
- NPI 1306798756
Hospital
-
- Orthopaedic Surgery Physician
- Harbor Beach, MI
- NPI 1508718958
Hospital
-
- Family Medicine Physician
- Harbor Beach, MI
- NPI 1659210128
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455667200000",
"number": "1083019012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45640 SCHOENHERR RD",
"address_2": "SUITE B",
"city": "UTICA",
"state": "MI",
"postal_code": "483156033",
"telephone_number": "586-247-4300",
"fax_number": "586-532-6496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2603 ELECTRIC AVE STE 1",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480606588",
"telephone_number": "810-987-5252",
"fax_number": "810-987-2120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAJARDO",
"first_name": "GUDALIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-04",
"last_updated": "2016-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704267837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.