Individual provider Active NPI

Samuel Nunez, LCSW

  • Clinical Social Worker
  • Santa Teresa, NM
National Provider Identifier
1083654537
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
02067 Issued in TX
Practice address
101 Livingston Loop Ste C1
Santa Teresa, NM 88008-9753
Phone
(575) 824-9000
Fax
(866) 596-6125
NPI assigned
Jun 6, 2006
Last updated
Nov 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X I-07343 NM
Clinical Social Worker 1041C0700X 02067 TX Primary

Addresses

Primary practice location

101 Livingston Loop Ste C1
Santa Teresa, NM 88008-9753

Mailing address

PO Box 1063
Santa Teresa, NM 88008-1063
Phone (575) 824-9000

Other identifiers 3

IdentifierTypeStateIssuer
99436311MedicaidNM
040468307MedicaidTX
040468308MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051007000552 TX Practitioner - Clinical Social Worker 5890710990
I20140609001026 NM Practitioner - Clinical Social Worker 5890710990 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Buen Salud IncGroup PAC ID 9931337060, 6 clinicians

Practice addresses (Care Compare)

101 Livingston Loop
Suite 1
Santa Teresa, NM 88008-9753
Phone (575) 824-9000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2067TXMDDental Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ruben I Aguilar Professional Consulting Services Inc CurrentSince Jan 9, 2013 Accepting new patients
Sunwest Behavioral Associates PA Past Accepting new patients
Long Term Care Services, LP Past Accepting new patients

Locations

10761 Pebble Hills Blvd
Ste F
El Paso, TX 79935
Phone (915) 594-8685

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1083654537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1063",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880081063",
            "telephone_number": "575-824-9000",
            "fax_number": "866-596-6125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LIVINGSTON LOOP STE C1",
            "city": "SANTA TERESA",
            "state": "NM",
            "postal_code": "880089753",
            "telephone_number": "575-824-9000",
            "fax_number": "866-596-6125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUNEZ",
        "first_name": "SAMUEL",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "I-07343",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "02067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99436311",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040468307",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040468308",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Teresa, NM

Sources for this page

Verify at the official NPI Registry.