NPIMap

Organization Active NPI

Pathology Consultants of New Mexico

  • Anatomic Pathology Physician
  • Roswell, NM
National Provider Identifier
1063498517
Registry record updated Jun 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology PhysicianTaxonomy code 207ZP0101X
Legal business name
PATHOLOGY CONSULTANTS OF NEW MEXICO
Practice address
600 N Richardson Ave
Roswell, NM 88201-4828
Phone
(505) 622-5600
Fax
(505) 622-3720
NPI assigned
Dec 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2020

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

Authorized official

Name
Lisa Moores
Title
Ceo/ Managing Partner
Phone
(575) 622-5600

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZC0500X
Hematology (Pathology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZH0000X
Immunopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZI0100X
Anatomic Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0101X Primary

Addresses

Primary practice location

600 N Richardson Ave
Roswell, NM 88201-4828

Mailing address

600 N Richardson Ave
Roswell, NM 88201-4828
Phone (505) 622-5600

Other identifiers 1

IdentifierTypeStateIssuer
52837MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080415000755 NM Part B Supplier - Independent Clinical Laboratory 8022196195 Practice locations: Las Cruces, NM; Roswell, NM

National Provider Directory

National Provider Directory
Tax ID family
Bayou Anesthesia and Pain PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1160 Commerce Dr
Ste A
Las Cruces, NM 88011
Phone (575) 522-0441

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1063498517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N RICHARDSON AVE",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882014828",
            "telephone_number": "505-622-5600",
            "fax_number": "505-622-3720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N RICHARDSON AVE",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882014828",
            "telephone_number": "505-622-5600",
            "fax_number": "505-622-3720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY CONSULTANTS OF NEW MEXICO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "MOORES",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CEO/ MANAGING PARTNER",
        "authorized_official_telephone_number": "575-622-5600"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Hematology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZI0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Immunopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52837",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.