Individual provider Active NPI

Courtney Marquez, PA-C

  • Medical Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1194387555
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9566 Issued in MA
Practice address
4901 Lang Ave NE
Albuquerque, NM 87109-4495
Phone
(505) 842-8171
NPI assigned
Jul 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA2019-0049 NM
Medical Physician Assistant 363AM0700X PA9566 MA Primary

Addresses

Primary practice location

4901 Lang Ave NE
Albuquerque, NM 87109-4495

Mailing address

4901 Lang Ave NE
Albuquerque, NM 87109-4495
Phone (505) 842-8171

Other identifiers 1

IdentifierTypeStateIssuer
49037544MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, MA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190819001217 NM Practitioner - Physician Assistant 0446588297 Reassigns benefits to 1 organization
I20231018002968 MA Practitioner - Physician Assistant 0446588297 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vantage Healthcare LLCGroup PAC ID 8224361191, 72 clinicians

Practice addresses (Care Compare)

100 Dr Julius Kelley LN
Pocasset, MA 02559-2134
Phone (208) 564-4474

1084 Broadway
Raynham, MA 02767-1976
Phone (508) 822-9400

12 Bluebird Rd
Wellesley, MA 02481-3503
Phone (774) 309-4129

290 Kingstown Way
Duxbury, MA 02332-4635
Phone (781) 585-2334

298 Kingstown Way
Duxbury, MA 02332-4647
Phone (784) 694-2205

300 Rosebrook Way
Wareham, MA 02571-1146
Phone (781) 867-2050

Hospital & facility affiliations

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: cmarquez277614@ahs.direct-ci.com

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.

Hospital & facility affiliations 6

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": "1562284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1194387555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 LANG AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094495",
            "telephone_number": "505-842-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 LANG AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094495",
            "telephone_number": "505-842-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARQUEZ",
        "first_name": "COURTNEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-05",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA2019-0049",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "PA9566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "49037544",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.