Dermatology of New Mexico LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DERMATOLOGY OF NEW MEXICO LLC

Practice address

610 Broadway Blvd NE
Albuquerque, NM 87102-2372

Phone

(505) 225-2500

Fax

(505) 225-2025

NPI assigned

Oct 8, 2019

Organization subpart

No

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

Authorized official

Name

Suraj2252500 Reddy, MDNPI 1740485275

Title

Ceo / MD

Phone

(505) 225-2500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Suraj Gopal Reddy, M.D.

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1740485275
  Medicare reassignment Care Compare group NPD Authorized official
• Shilpa Gopal Reddy, MD

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1639218639
  Medicare reassignment Care Compare group NPD
• Bradley Walters, PAC

  • Physician Assistant
  • Albuquerque, NM
  • NPI 1386077196
  Medicare reassignment Care Compare group NPD
• Sabrina M Johnson, PA-C

  • Physician Assistant
  • Albuquerque, NM
  • NPI 1497844203
  Medicare reassignment Care Compare group
• Kirsten Sochinski, PA-C

  • Medical Physician Assistant
  • Albuquerque, NM
  • NPI 1881321057
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1104468438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 BROADWAY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022372",
            "telephone_number": "505-225-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 BROADWAY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022372",
            "telephone_number": "505-225-2500",
            "fax_number": "505-225-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY OF NEW MEXICO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "SURAJ2252500",
        "authorized_official_title_or_position": "CEO / MD",
        "authorized_official_telephone_number": "505-225-2500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Dereu
• Lev B Deriy, MD
• Daniel Derksen, MD
• Dermatology & Skin Cancer Center of NM PC
• Dermatology Consultants of Albuquerque PC
• Adrianna Derrick
• Lorine Derusha
• Judith Des Jardins, SLP-CF
• Giavanna Desai, AUD
• Masoom Desai

• Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.