NPIMap

Organization Active NPI

Four Corners Nephrology Associates PC

  • Nephrology Physician
  • Farmington, NM
National Provider Identifier
1144327172
Registry record updated Apr 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
FOUR CORNERS NEPHROLOGY ASSOCIATES PC
Practice address
622 W Maple St Ste H
Farmington, NM 87401-6589
Phone
(505) 326-6521
Fax
(505) 325-6699
NPI assigned
Sep 20, 2006
Last updated
Apr 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Billie Stolworthy
Title
Office Manager
Phone
(505) 326-6521

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

622 W Maple St Ste H
Farmington, NM 87401-6589

Mailing address

622 W Maple St Ste H
Farmington, NM 87401-6589
Phone (505) 326-6521

Other identifiers 3

IdentifierTypeStateIssuer
311843MedicaidAZ
F3805MedicaidNM
94004736MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, AZ, UT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040216000348 NM Part B Supplier - Clinic/Group Practice 6204721731 Receives reassigned benefits from 7 practitioners
Practice locations: Farmington, NM
O20040713001291 AZ Part B Supplier - Clinic/Group Practice 6204721731 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Chinle, AZ; Kayenta, AZ; Polacca, AZ; Tuba City, AZ
O20101115001422 UT Part B Supplier - Clinic/Group Practice 6204721731 Receives reassigned benefits from 3 practitioners
Practice locations: Blanding, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

812 W Maple St
Farmington, NM 87401
Phone (505) 326-6521

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72546

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301616000000",
    "number": "1144327172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST STE H",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016589",
            "telephone_number": "505-326-6521",
            "fax_number": "505-325-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST STE H",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016589",
            "telephone_number": "505-326-6521",
            "fax_number": "505-325-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS NEPHROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-04-01",
        "status": "A",
        "authorized_official_last_name": "STOLWORTHY",
        "authorized_official_first_name": "BILLIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-326-6521",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "311843",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F3805",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94004736",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2011; 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.

Verify at the official NPI Registry.