Active NPI
Timothy Mike
- Social Worker
- Albuquerque, NM
National Provider Identifier
1104219229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- M-09515
- Practice address
- 707 Broadway Blvd NE Ste 500
Albuquerque, NM 87102 - Phone
- (505) 268-0701
- Fax
- (505) 232-9055
- NPI assigned
- Mar 13, 2015
- Last updated
- Sep 6, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | M-09515 | NM | Primary |
Addresses
Primary practice location
707 Broadway Blvd NE Ste 500
Albuquerque, NM 87102
Mailing address
707 Broadway Blvd NE Ste 500
Albuquerque, NM 87102-2367
Other practice location 1
5608 Zuni Rd SE
Albuquerque, NM 87108-2926
Phone (505) 515-3912
Other practice location 2
5608 Zuni Rd SE
Albuquerque, NM 87108-2926
Phone (505) 515-3912
Other practice location 3
100 W Griggs Ave
Las Cruces, NM 88001-1234
Phone (575) 647-2800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18677037 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-09515 | NM | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536192000000",
"number": "1104219229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 BROADWAY BLVD NE STE 500",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 BROADWAY BLVD NE STE 500",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87102",
"telephone_number": "505-268-0701",
"fax_number": "505-232-9055"
}
],
"practiceLocations": [
{
"address_1": "5608 Zuni Rd SE",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871082926",
"country_code": "US",
"telephone_number": "505-515-3912",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5608 Zuni Rd SE",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871082926",
"country_code": "US",
"telephone_number": "505-515-3912",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 W Griggs Ave",
"address_purpose": "LOCATION",
"city": "Las Cruces",
"state": "NM",
"postal_code": "880011234",
"country_code": "US",
"telephone_number": "575-647-2800",
"fax_number": "575-647-2898",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIKE",
"first_name": "TIMOTHY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-13",
"last_updated": "2018-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NM",
"license": "M-09515",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18677037",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.