Active NPI
Juan Fulgencio Mercado Guzman, PA-C
- Medical Physician Assistant
- Tinker Afb, OK
National Provider Identifier
1407204829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 7050 Air Depot Blvd
Tinker Afb, OK 73145-8716 - Phone
- (405) 582-6644
- NPI assigned
- May 26, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
7050 Air Depot Blvd
Tinker Afb, OK 73145-8716
Mailing address
7050 Air Depot Blvd
Tinker Afb, OK 73145-8716
Other practice location 1
18th Medical Group
unit 5142
Apo, AP 96368
Phone (315) 630-4780
Other practice location 2
96 MDSS/Sgne
307 Boatner RD
Eglin AFB, FL 32542
Phone (850) 883-8448
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Medical Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Edmond, OK
- NPI 1356574560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754006400000",
"number": "1407204829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7050 AIR DEPOT BLVD",
"city": "TINKER AFB",
"state": "OK",
"postal_code": "731458716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7050 AIR DEPOT BLVD",
"city": "TINKER AFB",
"state": "OK",
"postal_code": "731458716",
"telephone_number": "405-582-6644"
}
],
"practiceLocations": [
{
"address_1": "18th Medical Group",
"address_2": "unit 5142",
"address_purpose": "LOCATION",
"city": "APO",
"state": "AP",
"postal_code": "96368",
"country_code": "US",
"telephone_number": "315-630-4780",
"country_name": "United States",
"address_type": "MIL"
},
{
"address_1": "96 MDSS/SGNE",
"address_2": "307 Boatner RD",
"address_purpose": "LOCATION",
"city": "Eglin AFB",
"state": "FL",
"postal_code": "32542",
"country_code": "US",
"telephone_number": "850-883-8448",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MERCADO GUZMAN",
"first_name": "JUAN",
"middle_name": "FULGENCIO",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-26",
"last_updated": "2025-08-01",
"certification_date": "2025-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tinker Afb, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.