Individual provider Active NPI

Angelina Suzanne Campos, NP

  • Nurse Practitioner
  • Albuquerque, NM
National Provider Identifier
1104467042
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP61145506 Issued in WA
Practice address
8400 Osuna Rd NE Ste 2D
Albuquerque, NM 87111-2069
Phone
(877) 522-1275
Fax
(509) 491-3031
NPI assigned
Oct 2, 2019
Last updated
May 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 58262 NM
Nurse Practitioner 363L00000X AP61145506 WA Primary
Registered Nurse 163W00000X RN-75622 NM
Addiction (Substance Use Disorder) Registered Nurse 163WA0400X AP61145506 WA

Addresses

Primary practice location

8400 Osuna Rd NE Ste 2D
Albuquerque, NM 87111-2069

Mailing address

5615 Dunbarton Ave
Pasco, WA 99301-8216
Phone (509) 222-1275

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210902000824 WA Practitioner - Nurse Practitioner 5597190710 Reassigns benefits to 1 organization
I20240128000238 OR Practitioner - Nurse Practitioner 5597190710 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Counseling SolutionsGroup PAC ID 0446484885, 31 clinicians

Practice addresses (Care Compare)

550 W Sperry St
Heppner, OR 97836-2060
Phone (541) 676-9161

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN-75622NMMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Community Counseling Solutions CurrentSince Dec 18, 2023 Accepting new patients
Cascade Community Healthcare CurrentSince Jul 6, 2021 Accepting new patients
Community Counseling Solutions CurrentSince Dec 18, 2023 Accepting new patients
Cascade Community Healthcare CurrentSince Jul 6, 2021 Accepting new patients
Grant County Current Accepting new patients
Unm Hospital Past Accepting new patients

Locations

528 E Main St
Ste E
John Day, OR 97845
Phone (541) 575-0429

331 SE 2nd St
Pendleton, OR 97801
Phone (541) 276-6207

2428 W Reynolds Ave
Centralia, WA 98531

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.

NPI Registry JSON

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

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1104467042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 DUNBARTON AVE",
            "city": "PASCO",
            "state": "WA",
            "postal_code": "993018216",
            "telephone_number": "509-222-1275",
            "fax_number": "509-491-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 OSUNA RD NE STE 2D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112069",
            "telephone_number": "877-522-1275",
            "fax_number": "509-491-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPOS",
        "first_name": "ANGELINA",
        "middle_name": "SUZANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-02",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "58262",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61145506",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NM",
            "license": "RN-75622",
            "primary": false
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "AP61145506",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.