Individual provider Active NPI

Carol Tran, PA

  • Medical Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1043216179
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA2016-0057 Issued in NM
Practice address
3810 Masthead St NE
Albuquerque, NM 87109-4479
Phone
(058) 438-7585
Fax
(505) 843-8759
NPI assigned
Jun 23, 2005
Last updated
May 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2016-0057 NM Primary
Medical Physician Assistant 363AM0700X PA04560 TX

Addresses

Primary practice location

3810 Masthead St NE
Albuquerque, NM 87109-4479

Mailing address

3810 Masthead St NE
Albuquerque, NM 87109-4479
Phone (505) 843-8758

Other identifiers 2

IdentifierTypeStateIssuer
840878OtherTXBCBS
P00298578OtherRAILROAD MEDICARE

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
I20161205000050 NM Practitioner - Physician Assistant 0345262325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Omnisleep LLCGroup PAC ID 1658303987, 8 clinicians

Practice addresses (Care Compare)

3810 Masthead St NE
Albuquerque, NM 87109-4479
Phone (505) 843-8758

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4450AZMDClinical Neuropsychologist
1253OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Omnisleep LLC CurrentSince Oct 8, 2016 Accepting new patients
Orthopedic and Reconstructive Center P C Past Accepting new patients
The University of Texas Southwestern Medical Center at Dallas Past Accepting new patients
Abilene Cardiology Consultants PA Past Accepting new patients

Locations

3810 Masthead St NE
Albuquerque, NM 87109
Phone (505) 243-3514

6500 Jefferson St NE
Ste 100
Albuquerque, NM 87109
Phone (505) 843-8758

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1043216179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 MASTHEAD ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094479",
            "telephone_number": "505-843-8758",
            "fax_number": "505-843-8759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 MASTHEAD ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094479",
            "telephone_number": "058-438-7585",
            "fax_number": "505-843-8759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "CAROL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-23",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2016-0057",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA04560",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "840878",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00298578",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.