NPIMap

Organization Active NPI

Southwest Neuropsychology and Behavioral Health, LLC

  • Clinical Neuropsychologist
  • Albuquerque, NM
National Provider Identifier
1023315017
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
1148 Issued in NM
Legal business name
SOUTHWEST NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH, LLC
Practice address
320 Gold Ave SW
Suite 1001
Albuquerque, NM 87102-3202
Phone
(505) 247-4900
NPI assigned
Feb 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Authorized official

Name
Dr. Jonathan Ryan Kurtyka, PH.D.NPI 1104156058
Title
Organizer
Phone
(505) 247-4900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X 1148 NM Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 1148 NM
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X

Addresses

Primary practice location

320 Gold Ave SW
Suite 1001
Albuquerque, NM 87102-3202

Mailing address

320 Gold Ave SW
Suite 1001
Albuquerque, NM 87102-3202
Phone (505) 247-4900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110407000847 NM Part B Supplier - Clinic/Group Practice 9638353170 Receives reassigned benefits from 20 practitioners
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory
Tax ID family
Southwest Neuropsychology and Behavioral Health LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5951 Jefferson St NE
Ste C
Albuquerque, NM 87109
Phone (505) 247-4900

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1023315017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 GOLD AVE SW",
            "address_2": "SUITE 1001",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871023202",
            "telephone_number": "505-247-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 GOLD AVE SW",
            "address_2": "SUITE 1001",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871023202",
            "telephone_number": "505-247-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "KURTYKA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "505-247-4900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "NM",
            "license": "1148",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NM",
            "license": "1148",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; 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.