NPIMap

Organization Active NPI

Ac Micro Guam LLC

  • Anesthesiology Physician
  • Tamuning, GU
National Provider Identifier
1699768093
Registry record updated Aug 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0633184 Issued in GU
Legal business name
AC MICRO GUAM LLC
Practice address
633 Gov Carlos G Camacho Rd
Ste 101 Guam Medical Plaza
Tamuning, GU 96913-3143
Phone
(671) 646-3855
Fax
(671) 646-3854
NPI assigned
Aug 31, 2005
Last updated
Aug 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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

Authorized official

Name
Mrs. Melissa Waibel
Title
Administrator
Phone
(671) 646-3855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 0633184 GU Primary

Addresses

Primary practice location

633 Gov Carlos G Camacho Rd
Ste 101 Guam Medical Plaza
Tamuning, GU 96913-3143

Mailing address

633 Gov Carlos G Camacho Rd
Ste 101 Guam Medical Plaza
Tamuning, GU 96913-3143
Phone (671) 646-3855

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170911002844 GU Part B Supplier - Clinic/Group Practice 9133021710 Receives reassigned benefits from 12 practitioners
Practice locations: Tamuning, GU

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

633 Gov Carlos G Camacho Rd
Ste 101
Tamuning, GU 96913
Phone (671) 646-3855

850 Gov Carlos G Camacho Rd
Tamuning, GU 96913
Phone (671) 647-2555

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597017600000",
    "number": "1699768093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "633 GOV CARLOS G CAMACHO RD",
            "address_2": "STE 101 GUAM MEDICAL PLAZA",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133143",
            "telephone_number": "671-646-3855",
            "fax_number": "671-646-3854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 GOV CARLOS G CAMACHO RD",
            "address_2": "STE 101 GUAM MEDICAL PLAZA",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133143",
            "telephone_number": "671-646-3855",
            "fax_number": "671-646-3854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AC MICRO GUAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A",
        "authorized_official_last_name": "WAIBEL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "671-646-3855",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "GU",
            "license": "0633184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 10, 2020; 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.