Grace E. Wandersleben, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

022070 Issued in PR

Practice address

Carretera 188 KM 1.5 Barrio San Isidro
Canovanas, PR 00729-3998

Phone

(787) 957-2020

NPI assigned

Oct 25, 2020

Sex

Female

Sole proprietor

Yes

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 PR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• G & G Medical Group LLC

  • Health Service Clinic/Center
  • Canovanas, PR
  • NPI 1023734373
  Medicare reassignment NPD

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

{
    "created_epoch": "1603584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1376142844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "city": "RIO GRANDE",
            "state": "PR",
            "postal_code": "007450155",
            "telephone_number": "787-240-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARRETERA 188 KM 1.5 BARRIO SAN ISIDRO",
            "city": "CANOVANAS",
            "state": "PR",
            "postal_code": "007293998",
            "telephone_number": "787-957-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDERSLEBEN",
        "first_name": "GRACE",
        "middle_name": "E.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-25",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "022070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alejandra Andresa Villagrasa Flores, M.D.
• Angelica Cristina Villalobos, PA
• Wal-Mart Puerto Rico Inc
• Wal-Mart Puerto Rico Inc
• Walgreen Co
• William Rivera Transport Service, Inc
• Astrid Yamin, PSY.D
• Isamaris Yousef Maldonado, MPSY
• Ysm Inc
• Maria S Zamora Echevarria

• General Practice Physician in Canovanas, PR
• Providers in Canovanas, PR by specialty
• General Practice Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.