NPIMap

Organization Active NPI

Ybl PLLC

  • Diagnostic Radiology Physician
  • Tamuning, GU
National Provider Identifier
1295057503
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
M001519 Issued in GU
Legal business name
YBL PLLC
Practice address
643 Chalan San Antonio
Ste 109
Tamuning, GU 96913-3644
Phone
(671) 648-6390
Fax
(671) 648-6398
NPI assigned
Mar 1, 2010
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Vincent V Lizama, M.D.NPI 1417918764
Title
Manager
Phone
(671) 777-5259

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120413000671 GU Part B Supplier - Clinic/Group Practice 5395929392 Receives reassigned benefits from 7 practitioners
Practice locations: Tamuning, GU

National Provider Directory

National Provider Directory

Locations

643 Chalan San Antonio
Tamuning, GU 96913
Phone (671) 735-8000

643 Chalan San Antonio
Ste 109
Tamuning, GU 96913
Phone (671) 648-6390

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X M001519 GU Primary
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X M001519 GU

Addresses

NPPES NPI Registry

Primary practice location

643 Chalan San Antonio
Ste 109
Tamuning, GU 96913-3644

Mailing address

643 Chalan San Antonio
Ste 109
Tamuning, GU 96913-3644
Phone (671) 648-6390

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 15, 2011.

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1295057503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 CHALAN SAN ANTONIO",
            "address_2": "STE 109",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133644",
            "telephone_number": "671-648-6390",
            "fax_number": "671-648-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "643 CHALAN SAN ANTONIO",
            "address_2": "STE 109",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133644",
            "telephone_number": "671-648-6390",
            "fax_number": "671-648-6398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YBL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-01",
        "last_updated": "2011-09-15",
        "status": "A",
        "authorized_official_last_name": "LIZAMA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "16717775259",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GU",
            "license": "M001519",
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "GU",
            "license": "M001519",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tamuning, GU

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.