Individual provider Active NPI

Joaquin F Santillan, MPT

  • Physical Therapist
  • Santa Teresa, NM
National Provider Identifier
1003985565
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4955 Issued in NM
Practice address
103 Livingston Loop
Suite B1
Santa Teresa, NM 88008-9747
Phone
(575) 587-7061
Fax
(915) 493-8264
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1104438 TX
Physical Therapist 225100000X 4955 NM Primary

Addresses

Primary practice location

103 Livingston Loop
Suite B1
Santa Teresa, NM 88008-9747

Mailing address

4849 N Mesa St Ste 201
El Paso, TX 79912-5919
Phone (915) 351-6600

Other practice location 1

5360 N Mesa St Ste A1
El Paso, TX 79912-5820
Phone (915) 613-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170118001602 NM Practitioner - Physical Therapist in Private Practice 6507815156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thrive Wellness and Rehab PLLCGroup PAC ID 4688823925, 4 clinicians

Practice addresses (Care Compare)

103 Livingston Loop
Suite B1
Santa Teresa, NM 88008-9747
Phone (575) 587-7061

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4955NMMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Wellness and Rehab, P.L.L.C Physical Therapist CurrentSince Jan 2, 2017 Accepting new patients
Matrix Rehabilitation Ohio, Inc. Past Accepting new patients

Locations

103 Livingston Loop
Ste B1
Santa Teresa, NM 88008
Phone (575) 332-4246

Organizations & group practices 2

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1003985565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4849 N MESA ST STE 201",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799125919",
            "telephone_number": "915-351-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 LIVINGSTON LOOP",
            "address_2": "SUITE B1",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880089747",
            "telephone_number": "575-587-7061",
            "fax_number": "915-493-8264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5360 N Mesa St Ste A1",
            "address_purpose": "LOCATION",
            "city": "El Paso",
            "state": "TX",
            "postal_code": "799125820",
            "country_code": "US",
            "telephone_number": "915-613-2000",
            "fax_number": "915-613-4900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTILLAN",
        "first_name": "JOAQUIN",
        "middle_name": "F",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1104438",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "4955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Teresa, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.