Gary Cruz Bernabe, MD
Individual provider Active NPI Diagnostic Radiology Physician · Pago Pago, AS
NPI 1083174338 · NPPES record last updated Mar 22, 2019
Key facts
- NPI
- 1083174338
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 4115-C (AS)
- Practice address
- 96799 Turner Drive
Pago Pago, AS 96799-9994 - Phone
- (684) 633-1222
- Fax
- (684) 633-4102
- NPI assigned
- Mar 22, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240123001474 | AS | Practitioner - Diagnostic Radiology | 5496107773 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4115-C | AS | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Samoa Medical Center | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 4115-C | AS | Yes |
Addresses
Primary practice location
96799 Turner Drive
Pago Pago, AS 96799-9994
Mailing address
PO Box LBJ
Pago Pago, AS 96799-0010
Phone (684) 633-1222
Other providers in Pago Pago, AS
- Argel Aragon
- Mary Rose Aragon
- Gloria Avalos
- Bessie Ayala
- Miliakere Baleilevuka
- Luz Bernabe
- Josephine S Bernhardt
- Peni Moi Biukoto
- Ana Jane Bontia
- Saiasi Caginidaveta
All providers in Pago Pago, AS · Diagnostic Radiology Physician in American Samoa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.