Active NPI
TWC Abq
- Family Medicine Physician
- Albuquerque, NM
National Provider Identifier
1124891650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- TWC ABQ
- Practice address
- 6300 San Mateo Blvd NE Ste F2
Albuquerque, NM 87109-3536 - Phone
- (505) 818-1930
- Fax
- (505) 336-5399
- NPI assigned
- Nov 6, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark Anthony Cerna Jr.
- Title
- President
- Phone
- (505) 818-1930
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
6300 San Mateo Blvd NE Ste F2
Albuquerque, NM 87109-3536
Mailing address
6300 San Mateo Blvd NE Ste F2
Albuquerque, NM 87109-3536
Phone (505) 818-1930
Other names 1
- The Wellness Company
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231208002362 | NM | Part B Supplier - Clinic/Group Practice | 3375992860 |
Receives reassigned benefits from 1 practitioner Practice locations: Albuquerque, NM |
National Provider Directory
National Provider DirectoryLocations
6300 San Mateo Blvd NE
Ste F2
Albuquerque, NM 87109
Phone (505) 818-1930
6300 San Mateo Blvd NE
Albuquerque, NM 87109
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699228800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1699228800000",
"number": "1124891650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6300 SAN MATEO BLVD NE STE F2",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871093536",
"telephone_number": "505-818-1930",
"fax_number": "505-336-5399"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6300 SAN MATEO BLVD NE STE F2",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871093536",
"telephone_number": "505-818-1930",
"fax_number": "505-336-5399"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TWC ABQ",
"organizational_subpart": "NO",
"enumeration_date": "2023-11-06",
"last_updated": "2023-11-06",
"certification_date": "2023-11-06",
"status": "A",
"authorized_official_last_name": "CERNA",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "ANTHONY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "505-818-1930",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "The Wellness Company",
"code": "3",
"type": "Doing Business As"
}
]
}
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 Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.