Active NPI
Cleveland Hendrick Pardue III, MD
- Gynecology Physician
- Santa Fe, NM
National Provider Identifier
1174622393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 82101
- Practice address
- 465 St Michaels Drive
Suite 202
Santa Fe, NM 87505 - Phone
- (505) 984-0303
- Fax
- (505) 984-1116
- NPI assigned
- Sep 22, 2006
- Last updated
- Oct 24, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 82101 | NM | Primary |
Addresses
Primary practice location
465 St Michaels Drive
Suite 202
Santa Fe, NM 87505
Mailing address
455 Saint Michaels Dr
Physician Practices/Central Billing Office
Santa Fe, NM 87505-7601
Phone (505) 820-5227
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20404 | Medicaid | NM |
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 |
|---|---|---|---|
| 82101 | NM | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224806400000",
"number": "1174622393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "455 SAINT MICHAELS DR",
"address_2": "PHYSICIAN PRACTICES/CENTRAL BILLING OFFICE",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875057601",
"telephone_number": "505-820-5227",
"fax_number": "505-820-5645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "465 ST MICHAELS DRIVE",
"address_2": "SUITE 202",
"city": "SANTA FE",
"state": "NM",
"postal_code": "87505",
"telephone_number": "505-984-0303",
"fax_number": "505-984-1116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARDUE",
"first_name": "CLEVELAND",
"middle_name": "HENDRICK",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2008-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "NM",
"license": "82101",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20404",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Fe, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.