Jennifer Agosta, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD2008-0157 Issued in NM

Practice address

4351 E Lohman Ave Ste 320
Las Cruces, NM 88011-8262

Phone

(575) 556-3240

Fax

(575) 522-3092

NPI assigned

Apr 18, 2007

Last updated

Dec 21, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Familycare Associates,PA

  • Family Medicine Physician
  • Las Cruces, NM
  • NPI 1821161407
  NPD (past)

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513814400000",
    "number": "1174749014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4351 E LOHMAN AVE STE 320",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118262",
            "telephone_number": "575-556-3240",
            "fax_number": "575-522-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4351 E LOHMAN AVE STE 320",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118262",
            "telephone_number": "575-556-3240",
            "fax_number": "575-522-3092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4351 E Lohman Ave",
            "address_2": "Suite 409",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880118259",
            "country_code": "US",
            "telephone_number": "575-556-3240",
            "fax_number": "575-522-3092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGOSTA",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2017-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2008-0157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29380049",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "570315YY54",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Internal Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; 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.