NPIMap

Organization Active NPI

James M. Wilterding, M.D., LLC

  • Primary Care Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1174622666
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
2003-0249 Issued in NM
Legal business name
JAMES M. WILTERDING, M.D., LLC
Practice address
711 Encino PL NE
Suite D
Albuquerque, NM 87102-2619
Phone
(505) 265-2244
Fax
(505) 265-0557
NPI assigned
Sep 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
James M. Wilterding, M.D.NPI 1548218100
Title
Owner
Phone
(505) 265-2244

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 2003-0249 NM Primary

Addresses

Primary practice location

711 Encino PL NE
Suite D
Albuquerque, NM 87102-2619

Mailing address

711 Encino PL NE
Suite D
Albuquerque, NM 87102-2619
Phone (505) 265-2244

Other identifiers 3

IdentifierTypeStateIssuer
61238015MedicaidNM
PROVP16828OtherNMMOLINA SALUD
NM009M95OtherNMBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

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": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174622666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 ENCINO PL NE",
            "address_2": "SUITE D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022619",
            "telephone_number": "505-265-2244",
            "fax_number": "505-265-0557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 ENCINO PL NE",
            "address_2": "SUITE D",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022619",
            "telephone_number": "505-265-2244",
            "fax_number": "505-265-0557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES M. WILTERDING, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILTERDING",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-265-2244",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NM",
            "license": "2003-0249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61238015",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA SALUD",
            "identifier": "PROVP16828",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NM009M95",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.