NPIMap

Organization Active NPI

Guam Healthcare Development Incorporated

Doing business as GRMC Specialty Care Center

  • Clinic/Center
  • Dededo, GU
National Provider Identifier
1326447939
Registry record updated Oct 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GUAM HEALTHCARE DEVELOPMENT INCORPORATED
Doing business as
GRMC Specialty Care Center
Practice address
133 Route 3
Dededo, GU 96929-6911
Phone
(671) 645-5500
Fax
(671) 645-5549
NPI assigned
Aug 19, 2014
Last updated
Oct 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2024

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

Authorized official

Name
Alexander D. Wielaard, MDNPI 1144438995
Title
Chief Executive Officer
Phone
(706) 306-4668

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU 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 names 1

  • GRMC Specialty Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GU, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150326000266 GU Part B Supplier - Clinic/Group Practice 9234351776 Receives reassigned benefits from 430 practitioners
Practice locations: Dededo, GU; Tamuning, GU
O20250102000966 TN Part B Supplier - Clinic/Group Practice 9234351776 Practice locations: Morristown, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 444

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 444

NPI Registry JSON

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

{
    "created_epoch": "1408406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729987200000",
    "number": "1326447939",
    "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": "671-645-5549"
        },
        {
            "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": "671-645-5549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUAM HEALTHCARE DEVELOPMENT INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-19",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A",
        "authorized_official_last_name": "WIELAARD",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "706-306-4668",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRMC Specialty Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GRMC Specialty Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dededo, GU

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2024; 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.