Individual provider Active NPI

Jose E Catibog, MD

  • Pediatrics Physician
  • Fort Stewart, GA
National Provider Identifier
1922109115
Registry record updated Sep 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
LA10486R Issued in LA
Practice address
1061 Harmon Ave
Fort Stewart, GA 31314-5641
Phone
(912) 435-5555
NPI assigned
Sep 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 10486R LA
Pediatrics Physician 208000000X LA10486R LA Primary

Addresses

Primary practice location

1061 Harmon Ave
Fort Stewart, GA 31314-5641

Mailing address

1061 Harmon Avenue
Ft Stewart, GA 31314
Phone (912) 435-5555

Other identifiers 1

IdentifierTypeStateIssuer
1991741MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20050125000120 LA Practitioner - Pediatric Medicine 7416907878 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10486RLAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
C & M Medical Services, Inc. CurrentSince Jul 1, 1990 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
The Administrators of the Tulane Educational Fund Past Accepting new patients

Locations

2390 W Congress St
Lafayette, LA 70506
Phone (337) 261-6000

2202 False River Dr
New Roads, LA 70760
Phone (225) 638-5702

Organizations & group practices 3

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283817600000",
    "number": "1922109115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVENUE",
            "city": "FT STEWART",
            "state": "GA",
            "postal_code": "31314",
            "telephone_number": "912-435-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 HARMON AVE",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145641",
            "telephone_number": "912-435-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CATIBOG",
        "first_name": "JOSE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2010-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "10486R",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "LA10486R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1991741",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Stewart, GA

Sources for this page

Verify at the official NPI Registry.