Ruben a. Supan, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

RUBEN A. SUPAN, LLC

Practice address

405 W Country Club Rd
Roswell, NM 88201-5209

Phone

(575) 363-3134

Fax

(575) 208-0780

NPI assigned

May 29, 2018

Last updated

Jul 6, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ruben Supan, NPNPI 1619392883

Title

Nurse Practitioner

Phone

(505) 409-0831

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ruben Alfaro Supan, NP-C

  • Family Nurse Practitioner
  • Roswell, NM
  • NPI 1619392883
  Medicare reassignment Authorized official
• Kathleen Renee Price, APRN - CNP

  • Family Nurse Practitioner
  • Roswell, NM
  • NPI 1225635808
  Medicare reassignment NPD
• Babak Mirin, M.D.

  • Psychiatry Physician
  • Albuquerque, NM
  • NPI 1891776274
  Medicare reassignment

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1053802892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8244",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882028244",
            "telephone_number": "575-208-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W COUNTRY CLUB RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015209",
            "telephone_number": "575-363-3134",
            "fax_number": "575-208-0780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUBEN A. SUPAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-29",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "SUPAN",
        "authorized_official_first_name": "RUBEN",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "505-409-0831",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23386363",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roswell Osteopathic Medical Clinic, Inc
• Roswell Skin Center, LLC
• Roswell Surgery Center LLC
• Brianne Rowell, FNP
• Jane Laurie Rowland, L.I.S.W.
• Nohemi Rubio,, ASSOCIATE
• Lewis James Ruffing, SMPT
• Rossana Ruffing, LMT
• Venessa Ruiz
• Jeffery V. Ruzich, MD

• Family Nurse Practitioner in Roswell, NM
• Providers in Roswell, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.