Jessica Chynoweth, M.D
Individual provider Active NPI Family Medicine Physician · Isleta, NM
NPI 1083831051 · NPPES record last updated Jun 16, 2011
Key facts
- NPI
- 1083831051
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- RS20070280 (NM)
- Practice address
- 01 Sagebrush Street
Isleta, NM 87022 - Phone
- (505) 869-4385
- NPI assigned
- Apr 19, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110103000861 | NM | Practitioner - Family Practice | 5597953752 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RS20070280 | NM | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pueblo of Isleta | Current |
Accepting new patients | |
| Pueblo of Isleta | Current |
Accepting new patients | |
| Pueblo of Isleta | Past | Accepting new patients | |
| Pueblo of Isleta | Past | Accepting new patients |
Locations
1 Sagebrush St SW
Albuquerque, NM 87105
Phone (505) 869-4463
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | RS20070280 | NM | Yes |
Addresses
Primary practice location
01 Sagebrush Street
Isleta, NM 87022
Mailing address
PO Box 640
Isleta, NM 87022
Phone (505) 869-3200
Other providers in Isleta, NM
- Kaylee Briana Chavez
- Keely Justice Chavez
- Misti Marlene Chavez
- Lisa K Cherino
- Susan Stephanie Chewiwi
- Kimberly L. Conklan
- Lois Coomer
- Annie Felicia Coots
- Charlene Nicolette Gabaldon
- Roseann Garcia
All providers in Isleta, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.