NPIMap

Individual provider Active NPI

Edmund McNally, P.A.

  • Physician Assistant
  • Farmington, NM
National Provider Identifier
1184850372
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
91-PA04 Issued in NM
Practice address
301 S Lake St
Farmington, NM 87401-5619
Phone
(505) 278-8575
Fax
(505) 787-2399
NPI assigned
Jun 2, 2009
Last updated
Dec 4, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 91-PA04 NM Primary

Addresses

Primary practice location

301 S Lake St
Farmington, NM 87401-5619

Mailing address

301 S Lake St
Farmington, NM 87401-5619
Phone (505) 278-8575

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
I20140630000490 NM Practitioner - Physician Assistant 2062637358 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
My Kidney Care LLCGroup PAC ID 4587916747, 5 clinicians

Practice addresses (Care Compare)

301 S Lake St
Suite B
Farmington, NM 87401-5603
Phone (505) 278-8575

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
22.73 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
75.77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 1

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": "1243900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1184850372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S LAKE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015619",
            "telephone_number": "505-278-8575",
            "fax_number": "505-787-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S LAKE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015619",
            "telephone_number": "505-278-8575",
            "fax_number": "505-787-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCNALLY",
        "first_name": "EDMUND",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-02",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "91-PA04",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

Verify at the official NPI Registry.