Individual provider Active NPI

Michael Calica Agustin, M.D.

  • Pulmonary Disease Physician
  • Dededo, GU
National Provider Identifier
1215248356
Registry record updated May 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
M1976 Issued in GU
Practice address
133 Route 3
Dededo, GU 96929-6911
Phone
(671) 645-5500
Fax
(671) 969-4894
NPI assigned
Jun 23, 2010
Last updated
May 23, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2019

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X LP02041 RI
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 250235 MA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X M1976 GU
Pulmonary Disease Physician 207RP1001X 250235 MA
Pulmonary Disease Physician 207RP1001X M1976 GU Primary

Addresses

Primary practice location

133 Route 3
Dededo, GU 96929-6911

Mailing address

133 Route 3
Dededo, GU 96929-6911
Phone (671) 645-5500

Other practice location 1

736 Cambridge St
Brighton, MA 02135-2907
Phone (617) 789-2545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GU
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

Enrollment IDStateProvider typePAC IDDetails
I20161101001526 GU Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 2163700881 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Takecare Insurance Company IncGroup PAC ID 8325951239, 28 clinicians

Practice addresses (Care Compare)

133 Route 3
Dededo, GU 96929-6911
Phone (671) 645-5500

548 S Marine Corps Dr
Tamuning, GU 96913-3539
Phone (671) 646-5825

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.22 of 100Reported as group
Quality
78.84
Improvement activities
40
Cost
61.61

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP02041RIMDInternal Medicine Physician
M1976GUMDPulmonary Disease Physician
250235MAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Guam Healthcare Development Incorporated CurrentSince Sep 13, 2016 Accepting new patients
Takecare Insurance Company Inc. Internal Medicine CurrentSince Jun 24, 2024 Accepting new patients

Locations

133 Route 3
Dededo, GU 96929
Phone (671) 645-5500

548 S Marine Corps Dr
Tamuning, GU 96913
Phone (671) 646-5824

Organizations & group practices 2

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 1

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": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558569600000",
    "number": "1215248356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 ROUTE 3",
            "city": "DEDEDO",
            "state": "GU",
            "postal_code": "969296911",
            "telephone_number": "671-645-5500",
            "fax_number": "671-969-4894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 ROUTE 3",
            "city": "DEDEDO",
            "state": "GU",
            "postal_code": "969296911",
            "telephone_number": "671-645-5500",
            "fax_number": "671-969-4894"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "736 Cambridge St",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MA",
            "postal_code": "021352907",
            "country_code": "US",
            "telephone_number": "617-789-2545",
            "fax_number": "617-789-2893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGUSTIN",
        "first_name": "MICHAEL",
        "middle_name": "CALICA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-23",
        "last_updated": "2019-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "LP02041",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MA",
            "license": "250235",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "GU",
            "license": "M1976",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MA",
            "license": "250235",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "GU",
            "license": "M1976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dededo, GU

Sources for this page

Verify at the official NPI Registry.