Active NPI
John E Graham, MD
- Ophthalmology Physician
- Albuquerque, NM
National Provider Identifier
1104851187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 9261
- Practice address
- 5400 Gibson Blvd SE
Albuquerque, NM 87108 - Phone
- (505) 262-3937
- Fax
- (505) 262-7147
- NPI assigned
- Jul 11, 2006
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 9261 | NM | Primary |
Addresses
Primary practice location
5400 Gibson Blvd SE
Albuquerque, NM 87108
Mailing address
PO Box 27829
Albuquerque, NM 87125
Phone (505) 232-1920
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E4251 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9261 | NM | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optumcare Endoscopy Center New Mexico, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Albuquerque, NM
- NPI 1962685834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312848000000",
"number": "1104851187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27829",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87125",
"telephone_number": "505-232-1920",
"fax_number": "505-727-9276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5400 GIBSON BLVD SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87108",
"telephone_number": "505-262-3937",
"fax_number": "505-262-7147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "JOHN",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2011-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NM",
"license": "9261",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "E4251",
"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 Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.