Ethan Adler, FNP-BC
Individual provider Active NPI Nurse Practitioner · Albuquerque, NM
NPI 1134560618 · NPPES record last updated Jul 3, 2018
Key facts
- NPI
- 1134560618
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- CNO02214 (NM)
- Practice address
- 4121 Montgomery Blvd NE
Albuquerque, NM 87109 - Phone
- (505) 883-8099
- Fax
- (505) 299-2649
- NPI assigned
- Jul 11, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Adler Medical LLC
Practice addresses (Care Compare)
4121 Montgomery Blvd NE
Albuquerque, NM 87109-1102
Phone (505) 883-8099
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130925000813 | NM | Practitioner - Nurse Practitioner | 3577707975 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNO02214 | NM | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adler Medical LLC | Current |
Accepting new patients |
Locations
4121 Montgomery Blvd NE
Albuquerque, NM 87109
Phone (505) 314-0748
3804 Montgomery Blvd NE
Albuquerque, NM 87109
Phone (505) 883-8099
Interoperability endpoints
- ethanadler@aml-nm.direct.office.nextgen.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | CNO02214 | NM | Yes |
Addresses
Primary practice location
4121 Montgomery Blvd NE
Albuquerque, NM 87109
Mailing address
4121 Montgomery Blvd NE
Albuquerque, NM 87109-1102
Phone (505) 883-8099
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91924260 | Medicaid | NM |
Other providers in Albuquerque, NM
- Jamie Adkins
- Jeanelle Adkins
- Melissa Jeanette Adkins
- Zachary Edward Adkins
- Adler Medical LLC
- Michelle Ingrid Adler
- Molly Adler
- Kaye Scanlon Admire
- Ruaa Adnan
- Adobe Psychological Services PA
All providers in Albuquerque, NM · Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.