NPIMap

Individual provider Active NPI

Aedra D. Andrade, MD

  • Family Medicine Physician
  • Gallup, NM
National Provider Identifier
1164435673
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
NM2003-0155 Issued in NM
Practice address
610 N 5TH St
Gallup, NM 87301-5306
Phone
(505) 863-3120
Fax
(505) 863-2691
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NM2003-0155 NM Primary

Addresses

Primary practice location

610 N 5TH St
Gallup, NM 87301-5306

Mailing address

1504 Fairway Cir
Gallup, NM 87301-4937
Phone (505) 722-5008

Other identifiers 1

IdentifierTypeStateIssuer
16657055MedicaidNM

Other names 1

  • Aedra Dawn Wenger Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040607001357 NM Practitioner - Family Practice 2163404658 Reassigns benefits to 1 organization
I20250924003749 MO Practitioner - Family Practice 2163404658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Joplin LLC 288 clinicians

Practice addresses (Care Compare)

1615 Hazel Ave
Carthage, MO 64836-3020
Phone (417) 359-8803

Hospital & facility affiliations

  • Mercy Hospital Carthage Hospital, Carthage, MO, CCN 261338
  • Rehoboth McKinley Christian Health Care Services Hospital, Gallup, NM, CCN 321313
  • Mercy Hospital Joplin Hospital, Joplin, MO, CCN 260001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
NM2003-0155NMMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rehoboth McKinley Christian Health Care Services, Inc Family Medicine CurrentSince Aug 3, 2015 Accepting new patients
Rehoboth McKinley Christian Health Care Services, Inc. Current Accepting new patients
Rehoboth McKinley Christian Health Care Services, Inc CurrentSince Aug 3, 2015 Accepting new patients
Rehoboth McKinley Christian Health Care Services, Inc Current Accepting new patients
Mercy Clinic Joplin LLC Family Medicine CurrentSince Sep 8, 2025 Accepting new patients

Locations

1615 Hazel Ave
Carthage, MO 64836
Phone (417) 358-0188

94 Main St
Cassville, MO 65625
Phone (417) 782-7722

202 E 50th St
Joplin, MO 64804
Phone (417) 556-3400

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

2111 College Dr
Gallup, NM 87301
Phone (505) 397-5172

1901 Red Rock Dr
Gallup, NM 87301
Phone (505) 863-7000

1900 Red Rock Dr
Gallup, NM 87301
Phone (505) 863-1820

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1164435673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 FAIRWAY CIR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873014937",
            "telephone_number": "505-722-5008",
            "fax_number": "505-722-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N 5TH ST",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015306",
            "telephone_number": "505-863-3120",
            "fax_number": "505-863-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRADE",
        "first_name": "AEDRA",
        "middle_name": "D.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "NM2003-0155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16657055",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AEDRA",
            "last_name": "WENGER",
            "middle_name": "DAWN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Gallup, NM

Sources for this page

Verify at the official NPI Registry.