Kimberley B. Oldewage, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2011-0041 Issued in NM

Practice address

1350 Jackie Road Ste 101
Westside Family Medicine
Rio Rancho, NM 87124-1519

Phone

(505) 892-7518

Fax

(505) 892-9092

NPI assigned

Nov 17, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Presbyterian Healthcare Services

  • Internal Medicine Physician
  • Albuquerque, NM
  • NPI 1104802354
  Medicare reassignment NPD
• Presbyterian Healthcare Services

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1215913470
  NPD
• Genesis Physician Associates LLC

  • Internal Medicine Physician
  • Farmington, NM
  • NPI 1740569763
  NPD (past)
• Genesis Physician Associates LLC

  • Internal Medicine Physician
  • Albuquerque, NM
  • NPI 1902465263
  NPD (past)

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

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1003183187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 JACKIE ROAD STE 101",
            "address_2": "WESTSIDE FAMILY MEDICINE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241519",
            "telephone_number": "505-892-7518",
            "fax_number": "505-892-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 JACKIE ROAD STE 101",
            "address_2": "WESTSIDE FAMILY MEDICINE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241519",
            "telephone_number": "505-892-7518",
            "fax_number": "505-892-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDEWAGE",
        "first_name": "KIMBERLEY",
        "middle_name": "B.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-17",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2011-0041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunita Ochoa, LPCC
• George C Ochs, DPM
• Carrie Ohara, MT23007
• Alisa Dong Oilouch
• Ndidiamaka Okpareke, PHARMD, RPH
• Carmen Olguin, RN
• Carla V Olivas
• Kylie Olivas, SLP
• Olive Tree Pharmacy, Co.
• Olive Tree Specialty LLC

• Physician Assistant in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.