NPIMap

Individual provider Active NPI

Grace M Sally Mellgren, M.D.

  • Ophthalmology Physician
  • Roswell, NM
National Provider Identifier
1184709339
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD2015-0927 Issued in NM
Practice address
342 Sherrill LN
Roswell, NM 88201-5819
Phone
(575) 625-0123
Fax
(575) 625-0131
NPI assigned
Oct 26, 2006
Last updated
Apr 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD2015-0927 NM Primary
Ophthalmology Physician 207W00000X G53485 CA

Addresses

Primary practice location

342 Sherrill LN
Roswell, NM 88201-5819

Mailing address

342 Sherrill LN
Roswell, NM 88201-5819
Phone (575) 625-0123

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ07175ZOtherCABLUE SHIELD OF CA
00G53480MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160127002165 NM Practitioner - Ophthalmology 4981590452 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Loma Linda University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Engstrom Eye Center LLCGroup PAC ID 4385716729, 2 clinicians

Practice addresses (Care Compare)

342 Sherrill LN
Roswell, NM 88201-5819
Phone (575) 625-0123

8220 San Pedro Dr NE
Suite 220
Albuquerque, NM 87113-2480
Phone (505) 797-4466

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G53485CAMDOphthalmology Physician
MD2015-0927NMMDOphthalmology Physician
53485CAMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Cataract and Laser Institute Inc PC CurrentSince Apr 1, 2023 Accepting new patients
Pacific Cataract and Laser Institute, Inc., P.C. CurrentSince Apr 1, 2023 Accepting new patients
Engstrom Eye Center LLC Ophthalmology CurrentSince Dec 1, 2015 Accepting new patients
Roosevelt County Special Hospital District Current Accepting new patients
Pacific Cataract and Laser Institute, Inc., P.C. Past Accepting new patients

Locations

8220 San Pedro Dr NE
Ste 220
Albuquerque, NM 87113
Phone (360) 242-4610

342 Sherrill Ln
Roswell, NM 88201
Phone (575) 625-0123

342 Sherrill Ln
Ste 1
Roswell, NM 88201

Interoperability endpoints

  • Direct secure messaging: gracemellgren@rghnm.medalliesdirect.net
  • Direct secure messaging: grace.mellgren.p1@direct.pcli.nextgenshare.com

Organizations & group practices 5

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1184709339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 SHERRILL LN",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015819",
            "telephone_number": "575-625-0123",
            "fax_number": "760-721-7701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 SHERRILL LN",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015819",
            "telephone_number": "575-625-0123",
            "fax_number": "575-625-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLGREN",
        "first_name": "GRACE",
        "middle_name": "M SALLY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NM",
            "license": "MD2015-0927",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G53485",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZ07175Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G53480",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

Verify at the official NPI Registry.