Active NPI
Ismael Enrique Jusino-McDougall, MD
- General Practice Physician
- Guanica, PR
National Provider Identifier
1114935061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 5960
- Practice address
- 13 De Marzo St
#19
Guanica, PR 00653-1038 - Phone
- (787) 821-2879
- Fax
- (787) 821-2879
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 5960 | PR | Primary |
Addresses
Primary practice location
13 De Marzo St
#19
Guanica, PR 00653-1038
Mailing address
PO Box 1038
13 De Marzo St #19
Guanica, PR 00653-1038
Phone (787) 821-2879
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27214 | Other | SSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5960 | PR | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114935061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1038",
"address_2": "13 DE MARZO ST #19",
"city": "GUANICA",
"state": "PR",
"postal_code": "006531038",
"telephone_number": "787-821-2879",
"fax_number": "787-821-2879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13 DE MARZO ST",
"address_2": "#19",
"city": "GUANICA",
"state": "PR",
"postal_code": "006531038",
"telephone_number": "787-821-2879",
"fax_number": "787-821-2879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSINO-MCDOUGALL",
"first_name": "ISMAEL",
"middle_name": "ENRIQUE",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "PR",
"license": "5960",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SSS",
"identifier": "27214",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Guanica, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.