Active NPI
Marisell Burgos Mercado, PH.D.
- Clinical Psychologist
- San Juan, PR
National Provider Identifier
1295968915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2047
- Practice address
- 1290 Calle 54 SE
San Juan, PR 00921-3141 - Phone
- (787) 664-3816
- Fax
- (620) 506-4381
- NPI assigned
- Aug 27, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2047 | PR | Primary |
Addresses
Primary practice location
1290 Calle 54 SE
San Juan, PR 00921-3141
Mailing address
PO Box 190705
San Juan, PR 00919-0705
Phone (787) 390-7474
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110616000247 | PR | Practitioner - Clinical Psychologist | 8325225519 | Practice locations: San Juan, PR |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1290 Calle 54 SE
Urbanizacion la Riviera
San Juan, PR 00921-3141
Phone (787) 749-0333
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2047 | PR | MD | Nutrition Education Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579996800000",
"number": "1295968915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 190705",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009190705",
"telephone_number": "787-390-7474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1290 CALLE 54 SE",
"city": "SAN JUAN",
"state": "PR",
"postal_code": "009213141",
"telephone_number": "787-664-3816",
"fax_number": "620-506-4381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGOS MERCADO",
"first_name": "MARISELL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-27",
"last_updated": "2020-01-26",
"certification_date": "2020-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PR",
"license": "2047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2020; 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.
- 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.