Individual provider Active NPI

Carlos A. Jesurun, M.D.

  • Neonatal-Perinatal Medicine Physician
  • El Paso, TX
National Provider Identifier
1841303427
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
E1877 Issued in TX
Practice address
4800 Alberta Ave
El Paso, TX 79905-2709
Phone
(915) 545-6817
Fax
(915) 545-9799
NPI assigned
Aug 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E1877 TX
Neonatal-Perinatal Medicine Physician 2080N0001X E1877 TX Primary

Addresses

Primary practice location

4800 Alberta Ave
El Paso, TX 79905-2709

Mailing address

PO Box 9520
El Paso, TX 79995-9520
Phone (915) 545-6810

Other identifiers 1

IdentifierTypeStateIssuer
135094406MedicaidTX

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20081119000643 TX Practitioner - Pediatric Medicine 7416017520 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E1877TXMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatrix Medical Group of Texas Billing, Inc. Pediatrics CurrentSince Jan 1, 2017 Accepting new patients

Locations

2001 N Oregon St
El Paso, TX 79902
Phone (915) 577-6011

3001 George Bush Hwy
Ste 250
Richardson, TX 75082
Phone (888) 822-2855

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.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226880000000",
    "number": "1841303427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9520",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799959520",
            "telephone_number": "915-545-6810",
            "fax_number": "915-783-8187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 ALBERTA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799052709",
            "telephone_number": "915-545-6817",
            "fax_number": "915-545-9799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESURUN",
        "first_name": "CARLOS",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "E1877",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "TX",
            "license": "E1877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135094406",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.