Jacqueline Gesner Agcaoili, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A46231 Issued in CA

Practice address

4440 Brockton Ave.
Suite 320
Riverside, CA 92501

Phone

(951) 369-6191

Fax

(951) 369-0304

NPI assigned

Jun 8, 2005

Reactivated

Mar 29, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles (4 of 5)

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Jacqueline G. Agcaoili, MD Corporation

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1639212574

  CA, Internal Medicine

  Medicare reassignment NPD Authorized official
• Dignity Health

  • General Acute Care Hospital
  • San Bernardino, CA
  • NPI 1689769911
  NPD (past)
• Doctors Hospital of Riverside LLC

  • General Acute Care Hospital
  • Riverside, CA
  • NPI 1124596382
  NPD (past)
• Riverside Healthcare System, L.P.

  • Rehabilitation Hospital Unit
  • Riverside, CA
  • NPI 1053358010
  NPD (past)

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Care Alternatives of California, LLC

  • Community Based Hospice Care Agency
  • San Bernardino, CA
  • NPI 1437267309

  Corporate Director

  CMS ownership

Specialty

Internal Medicine

Education

Saint Louis University School of Medicine, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1124022108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 507",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92501",
            "telephone_number": "951-369-6191",
            "fax_number": "951-369-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 BROCKTON AVE.",
            "address_2": "SUITE 320",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92501",
            "telephone_number": "951-369-6191",
            "fax_number": "951-369-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGCAOILI",
        "first_name": "JACQUELINE",
        "middle_name": "GESNER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-08",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "deactivation_date": "2006-03-21",
        "reactivation_date": "2006-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A46231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suman Agarwal, MD
• Edilberto Lumelay Agas Jr., M.D.
• Nelson A Agbagwu, LVN
• Jordan Agbulos
• Fidelito Boado Agcaoili, PA-C
• Alishba Agha
• Maryam Agha
• Agile Occupational Medicine, PC
• Grace M Agosto
• Maria Agramon

• All providers in Riverside, CA
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.

Verify at the official NPI Registry.