NPIMap

Individual provider Active NPI

Caryl Guillermo, MD

  • Family Medicine Physician
  • Webster, TX
National Provider Identifier
1093043358
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N4443 Issued in TX
Practice address
250 Blossom St
Ste 400
Webster, TX 77598-4204
Phone
(281) 604-1300
Fax
(281) 724-0225
NPI assigned
Nov 25, 2009
Last updated
Oct 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X N4443 TX Primary

Addresses

Primary practice location

250 Blossom St
Ste 400
Webster, TX 77598-4204

Mailing address

250 Blossom St
Ste 400
Webster, TX 77598-4204
Phone (281) 604-1300

Other identifiers 3

IdentifierTypeStateIssuer
9165429OtherTXAETNA
211647701MedicaidTX
8F6729OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100203000164 TX Practitioner - Family Practice 8729121488 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Utmb Faculty Group PracticeGroup PAC ID 3375456734, 1,083 clinicians

Practice addresses (Care Compare)

2660 Gulf Fwy S
League City, TX 77573-6820

301 University Blvd
Galveston, TX 77555-5302
Phone (409) 772-2222

PO Box
650859 Dept 710
Dallas, TX 75265-0859

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N4443TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice CurrentSince Aug 9, 2018 Accepting new patients

Locations

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

511 Park Grove Dr
Katy, TX 77450
Phone (281) 398-7001

651 N Egret Bay Blvd
Ste H
League City, TX 77573
Phone (832) 632-1333

250 Blossom St
Ste 100
Webster, TX 77598
Phone (281) 724-0190

250 Blossom St
Ste 300
Webster, TX 77598

250 Blossom St
Ste 400
Webster, TX 77598
Phone (832) 632-7999

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1259107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475625600000",
    "number": "1093043358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 BLOSSOM ST",
            "address_2": "STE 400",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984204",
            "telephone_number": "281-604-1300",
            "fax_number": "281-724-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BLOSSOM ST",
            "address_2": "STE 400",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775984204",
            "telephone_number": "281-604-1300",
            "fax_number": "281-724-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLERMO",
        "first_name": "CARYL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-25",
        "last_updated": "2016-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N4443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9165429",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "211647701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8F6729",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Webster, TX

Sources for this page

Verify at the official NPI Registry.