Individual provider Active NPI

Mary Grace Aguilar Santos, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Sinajana, GU
National Provider Identifier
1669647772
Registry record updated Jul 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
M-1792 Issued in GU
Practice address
736 Route 4
Suite 103
Sinajana, GU 96910-3368
Phone
(671) 649-7232
Fax
(671) 649-7233
NPI assigned
Apr 29, 2008
Last updated
Jul 28, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125052317 IL
Geriatric Medicine (Internal Medicine) Physician 207RG0300X M-1792 GU Primary

Addresses

Primary practice location

736 Route 4
Suite 103
Sinajana, GU 96910-3368

Mailing address

736 Route 4
Suite 103
Sinajana, GU 96910-3368
Phone (671) 649-7232

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125052317ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Eyecare, LLC PastSince Sep 1, 2013 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469664000000",
    "number": "1669647772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 ROUTE 4",
            "address_2": "SUITE 103",
            "city": "SINAJANA",
            "state": "GU",
            "postal_code": "969103368",
            "telephone_number": "671-649-7232",
            "fax_number": "671-649-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 ROUTE 4",
            "address_2": "SUITE 103",
            "city": "SINAJANA",
            "state": "GU",
            "postal_code": "969103368",
            "telephone_number": "671-649-7232",
            "fax_number": "671-649-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS",
        "first_name": "MARY GRACE",
        "middle_name": "AGUILAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2016-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125052317",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "GU",
            "license": "M-1792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sinajana, GU

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.