Active NPI
Edward Joseph Neidhardt, MD
- Psychiatry Physician
- Santa Fe, NM
National Provider Identifier
1114089000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 89267
- Practice address
- 103 S Saint Francis Dr
Suite C
Santa Fe, NM 87501-2458 - Phone
- (505) 988-5667
- Fax
- (505) 820-1632
- NPI assigned
- Dec 15, 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 89267 | NM | Primary |
Addresses
Primary practice location
103 S Saint Francis Dr
Suite C
Santa Fe, NM 87501-2458
Mailing address
103 S Saint Francis Dr
Suite C
Santa Fe, NM 87501-2458
Phone (505) 988-5667
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000K3526 | Medicaid | NM | |
| 41814 | Medicaid | NM | |
| HSZ196 | Other | NM | MEDICARE PART B |
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 |
|---|---|---|---|
| 89267 | NM | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catalina M Perez-Lacey MD PA | Psychiatry | Past | Accepting new patients |
| Jicarilla IHS Pharmacy | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychiatry Physician
- Santa Fe, NM
- NPI 1679858955
-
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Dulce, NM
- NPI 1124220900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372291200000",
"number": "1114089000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 S SAINT FRANCIS DR",
"address_2": "SUITE C",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875012458",
"telephone_number": "505-988-5667",
"fax_number": "505-820-1632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 S SAINT FRANCIS DR",
"address_2": "SUITE C",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875012458",
"telephone_number": "505-988-5667",
"fax_number": "505-820-1632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEIDHARDT",
"first_name": "EDWARD",
"middle_name": "JOSEPH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-15",
"last_updated": "2013-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NM",
"license": "89267",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000K3526",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41814",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PART B",
"identifier": "HSZ196",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.