Individual provider Active NPI

Karen E McClary, PT

  • Physical Therapist
  • Las Cruces, NM
National Provider Identifier
1174830111
Registry record updated Oct 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4149 Issued in NM
Practice address
2205 S Main St
Las Cruces, NM 88005-3113
Phone
(575) 652-3515
Fax
(575) 652-3518
NPI assigned
Sep 13, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60185600 WA
Physical Therapist 225100000X 4149 NM Primary

Addresses

Primary practice location

2205 S Main St
Las Cruces, NM 88005-3113

Mailing address

2404 S. Locust St
Ste 5
Las Cruces, NM 88001-5789
Phone (575) 521-4188

Other identifiers 15

IdentifierTypeStateIssuer
03339MCOtherWAREGENCE
0333MCOtherWAREGENCE
0334MCOtherWAREGENCE
1174830111OtherWADSHS
0270986OtherWADEPT OF L&I
0336MCOtherWAREGENCE
0270990OtherWADEPT OF L&I
0270993OtherWADEPT OF L&I
0341MCOtherWAREGENCE
P00893794OtherWARAILROAD MEDICARE
0332MCOtherWAREGENCE
0335MCOtherWAREGENCE
0271004OtherWADEPT OF L&I
0338MCOtherWAREGENCE
0340MCOtherWAREGENCE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120920000085 NM Practitioner - Physical Therapist in Private Practice 7214123918 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

4151 Camino Coyote
Las Cruces, NM 88011-7096
Phone (575) 522-0484

Merit-based Incentive Payment System (MIPS)

Final score
19.58 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
65.27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4149NMMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy and Rehabilitation Services of Las Cruces, LLC Physical Therapist CurrentSince Feb 20, 2018 Accepting new patients
Real View Diagnostics LLC Physical Therapist Past Accepting new patients
Integrated Rehabilitation Group, PC Physical Therapist Past Accepting new patients
Elixir Physical Therapy LLC Physical Therapist Past Accepting new patients

Locations

4151 Camino Coyote
Las Cruces, NM 88011
Phone (575) 522-0484

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445817600000",
    "number": "1174830111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 S. LOCUST ST",
            "address_2": "STE 5",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015789",
            "telephone_number": "575-521-4188",
            "fax_number": "575-521-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 S MAIN ST",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053113",
            "telephone_number": "575-652-3515",
            "fax_number": "575-652-3518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLARY",
        "first_name": "KAREN",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-13",
        "last_updated": "2015-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60185600",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "4149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "03339MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0333MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0334MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS",
            "identifier": "1174830111",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "0270986",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0336MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "0270990",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "0270993",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0341MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00893794",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0332MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0335MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "0271004",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0338MC",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "0340MC",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; 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.