Active NPI
Jaron Wilson
- Student in an Organized Health Care Education/Training Program
- Albuquerque, NM
National Provider Identifier
1043057458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- Msc10 5600
1 University of New Mexico
Albuquerque, NM 81731-0001 - Phone
- (505) 272-2231
- NPI assigned
- Jul 12, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NM | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
Msc10 5600
1 University of New Mexico
Albuquerque, NM 81731-0001
Mailing address
4621 W Purdue Ave
Glendale, AZ 85302
Phone (916) 402-4046
Other practice location 1
19555 N 59th Ave
Glendale, AZ 85308-6813
Phone (623) 572-3200
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250514003181 | NM | Order and Referring Only - Orthopedic Surgery | 9638697535 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744070400000",
"number": "1043057458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4621 W PURDUE AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "85302",
"telephone_number": "916-402-4046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MSC10 5600",
"address_2": "1 UNIVERSITY OF NEW MEXICO",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "817310001",
"telephone_number": "505-272-2231"
}
],
"practiceLocations": [
{
"address_1": "19555 N 59th Ave",
"address_purpose": "LOCATION",
"city": "Glendale",
"state": "AZ",
"postal_code": "853086813",
"country_code": "US",
"telephone_number": "623-572-3200",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "JARON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-12",
"last_updated": "2025-04-08",
"certification_date": "2025-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NM",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"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 Apr 8, 2025; 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.