NPIMap

Individual provider Active NPI

Lisa A Wentling, PA-C

  • Family Medicine Physician
  • Cimarron, NM
National Provider Identifier
1083885560
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
PA2008-0063 Issued in NM
Practice address
31039 Hwy 64 # B
Cimarron, NM 87714-9646
Phone
(575) 376-2402
NPI assigned
Mar 12, 2008
Last updated
Oct 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X C0002467 MD
Family Medicine Physician 207Q00000X 2008-0063 NM
Family Medicine Physician 207Q00000X PA2008-0063 NM Primary

Addresses

Primary practice location

31039 Hwy 64 # B
Cimarron, NM 87714-9646

Mailing address

PO Box 625
Cimarron, NM 87714-0625
Phone (575) 376-2402

Other identifiers 2

IdentifierTypeStateIssuer
CS00214130OtherNMPHARMACY
PA2008-0063OtherNMLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090213000290 NM Practitioner - Physician Assistant 6406911064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11 Elliott Barker LN
Angel Fire, NM 87710-0133
Phone (575) 377-3301

PO Box
Suite 625
Cimarron, NM 87714-0625

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2008-0063NMMDFamily Medicine Physician
C0002467MDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Colfax County Hospital District CurrentSince May 11, 2021 Accepting new patients
Heavenleigh Hands PastSince Feb 23, 2025 Accepting new patients
Medlantic Healthcare Group Past Accepting new patients
South Central Colfax County Special Hospital District PastSince Dec 1, 2024 Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

31039 Highway 64
#B
Cimarron, NM 87714
Phone (575) 376-2402

Interoperability endpoints

  • Direct secure messaging: lisa.wentling.1@3427.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1083885560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 625",
            "city": "CIMARRON",
            "state": "NM",
            "postal_code": "877140625",
            "telephone_number": "575-376-2402",
            "fax_number": "575-376-2107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31039 HWY 64 # B",
            "city": "CIMARRON",
            "state": "NM",
            "postal_code": "877149646",
            "telephone_number": "575-376-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENTLING",
        "first_name": "LISA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-12",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0002467",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "2008-0063",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "PA2008-0063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY",
            "identifier": "CS00214130",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA2008-0063",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cimarron, NM

Sources for this page

Verify at the official NPI Registry.