Active NPI
Donald Lee Kettwich, M.D.
- Urology Physician
- Albuquerque, NM
National Provider Identifier
1124179486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 76-208
- Practice address
- 711 Encino PL NE
Suite E
Albuquerque, NM 87102-2619 - Phone
- (505) 245-5737
- Fax
- (505) 245-5739
- NPI assigned
- Jan 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | 76-208 | NM | Primary |
Addresses
Primary practice location
711 Encino PL NE
Suite E
Albuquerque, NM 87102-2619
Mailing address
711 Encino PL NE
Suite E
Albuquerque, NM 87102-2619
Phone (505) 245-5737
Other identifiers 17
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00015941 | Medicaid | NM | |
| 85-0284119 | Other | NM | JOHN ALDEN |
| 00NM019E05 | Other | NM | BLUE CROSS-BLUE SHIELD-NM |
| 85-0284119 | Other | NM | TRICARE FOR LIFE |
| 85-0284119 | Other | NM | IBEW-NECA |
| 85-0284119 | Other | NM | GEHA |
| 85-0284119 | Other | NM | AARP |
| 85-0284119 | Other | NM | E.B.C. |
| 201005185 | Other | NM | PRESBYTERIAN HEALTH PLAN |
| 85-0284119 | Other | NM | LOVELACE HEALTH PLAN |
| 85-0284119 | Other | NM | PRINCIPAL LIFE INS. |
| 85-0284119 | Other | NM | UNITED HEALTHCARE |
| 85-0284119 | Other | NM | CIGNA |
| 85-0284119 | Other | NM | UPREHS |
| 85-0284119 | Other | NM | UNITED AMERICAN |
| 85-0284119 | Other | NM | N.M. PIPE TRADES |
| 85-0284119 | Other | NM | AETNA |
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 |
|---|---|---|---|
| 76-208 | NM | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211500800000",
"number": "1124179486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 ENCINO PL NE",
"address_2": "SUITE E",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022619",
"telephone_number": "505-245-5737",
"fax_number": "505-245-5739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 ENCINO PL NE",
"address_2": "SUITE E",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871022619",
"telephone_number": "505-245-5737",
"fax_number": "505-245-5739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTWICH",
"first_name": "DONALD",
"middle_name": "LEE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-15",
"last_updated": "2008-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "NM",
"license": "76-208",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00015941",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN ALDEN",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS-BLUE SHIELD-NM",
"identifier": "00NM019E05",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE FOR LIFE",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IBEW-NECA",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEHA",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AARP",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "E.B.C.",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN HEALTH PLAN",
"identifier": "201005185",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LOVELACE HEALTH PLAN",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRINCIPAL LIFE INS.",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UPREHS",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED AMERICAN",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "N.M. PIPE TRADES",
"identifier": "85-0284119",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "85-0284119",
"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 May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.