NPIMap

Organization Active NPI

The Doctors Clinic

  • Family Medicine Physician
  • Tamuning, GU
National Provider Identifier
1467503433
Registry record updated Nov 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
THE DOCTORS CLINIC
Practice address
851 Governor Carlos Camacho Road
Tamuning, GU 96913-3153
Phone
(671) 648-2711
Fax
(671) 646-3639
NPI assigned
Jan 16, 2007
Last updated
Nov 29, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2007

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

Authorized official

Name
Mr. Benny M Paulino
Title
Chief Operating Officer
Phone
(671) 647-5212

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Surgery Physician 208600000X
Podiatrist 213E00000X

Addresses

Primary practice location

851 Governor Carlos Camacho Road
Tamuning, GU 96913-3153

Mailing address

PO Box 11409
Tamuning, GU 96931-1409
Phone (671) 647-5212

Other names 1

  • Family Medical Clinic Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160602001446 GU Part B Supplier - Clinic/Group Practice 3779472584 Receives reassigned benefits from 5 practitioners
Practice locations: Tamuning, GU

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196294400000",
    "number": "1467503433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11409",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969311409",
            "telephone_number": "671-647-5212",
            "fax_number": "671-647-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 GOVERNOR CARLOS CAMACHO ROAD",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133153",
            "telephone_number": "671-648-2711",
            "fax_number": "671-646-3639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DOCTORS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-11-29",
        "status": "A",
        "authorized_official_last_name": "PAULINO",
        "authorized_official_first_name": "BENNY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "671-647-5212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Nov 29, 2007; 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.