NPIMap

Individual provider Active NPI

Mark Himes, DO

  • Sports Medicine (Family Medicine) Physician
  • Farmington, NM
National Provider Identifier
1043571458
Registry record updated Apr 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
A-1969-16 Issued in NM
Practice address
622 W Maple St
Ste B
Farmington, NM 87401-6590
Phone
(505) 327-4867
NPI assigned
Jun 1, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X A-1969-16 NM Primary

Addresses

Primary practice location

622 W Maple St
Ste B
Farmington, NM 87401-6590

Mailing address

622 W Maple St
Ste B
Farmington, NM 87401-6589
Phone (505) 327-4867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160609000150 NM Practitioner - Family PracticePractitioner - Sports Medicine 2163712860 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
San Juan Medical Group PCGroup PAC ID 2264468503, 11 clinicians

Practice addresses (Care Compare)

622 W Maple St
Suite B
Farmington, NM 87401-6589
Phone 5053274867106

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions23
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
San Juan Medical Group PC CurrentSince Jul 25, 2016 Accepting new patients

Locations

622 W Maple St
Ste B
Farmington, NM 87401
Phone (505) 327-4867

Interoperability endpoints

  • Direct secure messaging: mark.a.himes.1@11485.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/11485/brand/4/csg/1/fhir/r4

Organizations & group practices 1

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 8

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": "1338508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491436800000",
    "number": "1043571458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST",
            "address_2": "STE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016589",
            "telephone_number": "505-327-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST",
            "address_2": "STE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016590",
            "telephone_number": "505-327-4867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIMES",
        "first_name": "MARK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-01",
        "last_updated": "2017-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NM",
            "license": "A-1969-16",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

Verify at the official NPI Registry.