Individual provider Active NPI

Grady Fowler

  • Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1033756887
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2100 Louisiana Blvd NE Ste 410
Albuquerque, NM 87110-5412
Phone
(505) 724-4300
Fax
(505) 338-0034
NPI assigned
Nov 27, 2019
Last updated
Jan 6, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU Primary

Addresses

Primary practice location

2100 Louisiana Blvd NE Ste 410
Albuquerque, NM 87110-5412

Mailing address

2100 Louisiana Blvd NE
Ste 410
Albuquerque, NM 87110-5412
Phone (505) 724-4300

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200220002140 NM Practitioner - Physician Assistant 4688001217 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2100 Louisiana Blvd NE
Suite 410
Albuquerque, NM 87110-5412
Phone 50572443003208

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
69.97 of 100Reported as individual
Quality
54.77
Promoting interoperability
73
Improvement activities
40
Cost
67.61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Mar 16, 2020 Accepting new patients
Presbyterian Healthcare Services CurrentSince Mar 16, 2020 Accepting new patients
New Mexico Orthopaedic Associates PC CurrentSince Dec 20, 2021 Accepting new patients

Locations

1700 Louisiana Blvd NE
Albuquerque, NM 87110
Phone (505) 724-4300

2100 Louisiana Blvd NE
Ste 410
Albuquerque, NM 87110
Phone (505) 724-4300

8300 Constitution Ave NE
Albuquerque, NM 87110
Phone (505) 291-2000

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1033756887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 LOUISIANA BLVD NE",
            "address_2": "STE 410",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871105412",
            "telephone_number": "505-724-4300",
            "fax_number": "505-338-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 LOUISIANA BLVD NE STE 410",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871105412",
            "telephone_number": "505-724-4300",
            "fax_number": "505-338-0034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "GRADY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-27",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.