Myrna Gacusan

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

151283 Issued in GA

Practice address

6911 Tara Blvd
Jonesboro, GA 30236-1503

Phone

(770) 477-8573

Fax

(770) 477-8573

NPI assigned

Jul 14, 2016

Sex

Female

Sole proprietor

No

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 GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HIAABD

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.

• Infectious Disease Consultants, PC

  • Infectious Disease Physician
  • Suwanee, GA
  • NPI 1225087745
  Medicare reassignment NPD
• Transitional Care Physicians of Georgia PC

  • Specialist
  • Monroe, GA
  • NPI 1619317542
  Medicare reassignment NPD

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

{
    "created_epoch": "1468454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1174976088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4395 ABBOTTS POINTE CT",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300972199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6911 TARA BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361503",
            "telephone_number": "770-477-8573",
            "fax_number": "770-477-8573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GACUSAN",
        "first_name": "MYRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-14",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "151283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latesha Funches
• Future Success Service
• Ga Champion Project Inc
• Renata Gabriel
• Gabriels Recreational Center, LLC
• Gardens of Grace Living Facility
• Gayla Darnell Gates, MD
• J. Claude Gauthier, M.D.
• Christopher Lawrence Gaydos, MD
• Generational Hospice Inc

• Family Nurse Practitioner in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.