Jeremy Ganz, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

27TH Special Operations Medical Group
224 W D. L. Ingram Avenue, BLDG. 1408
Clovis, NM 88103

Phone

(314) 226-8463

NPI assigned

Jun 18, 2018

Last updated

Jan 22, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

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.

• Fedko Emergency Physicians New Mexico LLC

  • Emergency Medicine Physician
  • Grants, NM
  • NPI 1770047441
  Medicare reassignment

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1053805671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27TH SPECIAL OPERATIONS MEDICAL GROUP",
            "address_2": "224 W D. L. INGRAM AVENUE, BLDG. 1408",
            "city": "CANNON AFB",
            "state": "NM",
            "postal_code": "88103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27TH SPECIAL OPERATIONS MEDICAL GROUP",
            "address_2": "224 W D. L. INGRAM AVENUE, BLDG. 1408",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "88103",
            "telephone_number": "314-226-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANZ",
        "first_name": "JEREMY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhonda R Gallegos, REHAB COORD
• Roxann A Gallegos, BMS
• Ryan Galloway
• Melissa Galvan, TECHNICIAN-OTHER
• Vikram Ganupur
• Crystal L Garcia, BMS
• Donna Garcia
• Fheb G Garcia, PT
• Jonathan Jose Luis Garcia
• Jose Garcia

• Physician Assistant in Clovis, NM
• Providers in Clovis, 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 Jan 22, 2024; 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.