Dominic Tellez, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2009-0029 Issued in NM

Practice address

1600 Phtorpe Road
Las Cruces, NM 88012

Phone

(575) 526-6200

Fax

(575) 526-2266

NPI assigned

Sep 23, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Truth Or Consequences, NM
  • NPI 1871528505
  Medicare reassignment
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Deming, NM
  • NPI 1194443135
  NPD
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Radium Springs, NM
  • NPI 1770734865
  NPD
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Las Cruces, NM
  • NPI 1699105320
  NPD (past)
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Alamogordo, NM
  • NPI 1902831977
  NPD (past)

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

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253664000000",
    "number": "1043544091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "HATCH",
            "state": "NM",
            "postal_code": "879370370",
            "telephone_number": "575-267-3280",
            "fax_number": "575-267-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 PHTORPE ROAD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "88012",
            "telephone_number": "575-526-6200",
            "fax_number": "575-526-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELLEZ",
        "first_name": "DOMINIC",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-23",
        "last_updated": "2009-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2009-0029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sally M Telles, CSW
• Valeria Tellez-Giron
• Angela Lynn Tellez
• Antonio Tellez
• Cynthia Elizabeth Tellez, CASE MANAGER
• Jill Tellez, CNM
• Telshor Family Clinic LLC
• Charlene K Templet, LPCC
• Sarah B Templeton, LSAA
• Tend LLC

• Physician Assistant in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2009; 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.

Verify at the official NPI Registry.