NPIMap

Organization Active NPI

Western Dermatology Consultants PC

  • MOHS-Micrographic Surgery Physician
  • Albuquerque, NM
National Provider Identifier
1174653299
Registry record updated Mar 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
WESTERN DERMATOLOGY CONSULTANTS PC
Practice address
10151 Montgomery Blvd NE
BLDG. 1 Ste. a
Albuquerque, NM 87111-3670
Phone
(505) 855-5503
NPI assigned
Mar 7, 2007
Last updated
Mar 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2008

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

Authorized official

Name
Dr. Leslie Glass, MDNPI 1164455275
Title
President
Phone
(505) 855-5503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ND0101X NM Primary

Addresses

Primary practice location

10151 Montgomery Blvd NE
BLDG. 1 Ste. a
Albuquerque, NM 87111-3670

Mailing address

10151 Montgomery NE BLDG. 1
Ste. a
Albuquerque, NM 87111
Phone (505) 855-5503

Other identifiers 1

IdentifierTypeStateIssuer
P6441MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080206000203 NM Part B Supplier - Clinic/Group Practice 4880777432 Receives reassigned benefits from 9 practitioners
Practice locations: Albuquerque, NM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D0941746Western Dermatology Consultants PC10151 Montgomery NE 1a, Albuquerque, NM 87111Provider-performed microscopyMar 9, 2027

National Provider Directory

National Provider Directory

Locations

10151 Montgomery Blvd NE
Bldg 1
Albuquerque, NM 87111
Phone (505) 273-5054

10151 Montgomery Blvd NE
Ste 1A
Albuquerque, NM 87111
Phone (505) 855-5503

10151 Montgomery Blvd NE
Ste A
Albuquerque, NM 87111
Phone (505) 275-0910

10151 Montgomery Blvd NE
Ste B
Albuquerque, NM 87111
Phone (505) 275-1663

4801 McMahon Blvd NW
Ste 270
Albuquerque, NM 87114
Phone (505) 589-7131

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1174653299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10151 MONTGOMERY NE BLDG. 1",
            "address_2": "STE. A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87111",
            "telephone_number": "505-855-5503",
            "fax_number": "505-855-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10151 MONTGOMERY BLVD NE",
            "address_2": "BLDG. 1 STE. A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113670",
            "telephone_number": "505-855-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN DERMATOLOGY CONSULTANTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-855-5503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P6441",
            "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 Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.