Dermatology of Santa Fe PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD2004-0502 Issued in NM

Legal business name

DERMATOLOGY OF SANTA FE PC

Practice address

2019 Galisteo St
Suite N-9B
Santa Fe, NM 87505-2143

Phone

(505) 986-9688

Fax

(505) 986-9090

NPI assigned

Mar 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth A Jester, MD

Title

Owner

Phone

(505) 986-9688

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 3

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

• Beth A Jester, MD

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1548260995

  Dermatology, NM

  Medicare reassignment NPD
• Jessica Ellen Fertig, PA-C

  • Physician Assistant
  • Santa Fe, NM
  • NPI 1700308871

  NM

  Medicare reassignment
• Diane M. Reisinger, MD

  • MOHS-Micrographic Surgery Physician
  • Santa Fe, NM
  • NPI 1003975699
  NPD

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043344476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 GALISTEO ST",
            "address_2": "SUITE N9B",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875052143",
            "telephone_number": "505-986-9688",
            "fax_number": "505-986-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2019 GALISTEO ST",
            "address_2": "SUITE N-9B",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875052143",
            "telephone_number": "505-986-9688",
            "fax_number": "505-986-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY OF SANTA FE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JESTER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-986-9688",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "NM",
            "license": "MD2004-0502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548260995",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juan Carlos Deoses Burciaga, LCSW
• Department of Health - Public Health Division
• Department of Health, Public Health Division
• Department of Health, Public Health Division
• Department of Health, Public Health Division
• Dermatology Partners of Northern New Mexico
• Kendall Derosso
• Desert Mountain Skin Cancer Surgery, LLC
• Desert Rain Chiropractic
• Desert Rain Midwifery, LLC

• All providers in Santa Fe, NM
• Dermatology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.