NPIMap

Individual provider Active NPI

Dallas W Lipscomb, PA-C

  • Physician Assistant
  • Elephant Butte, NM
National Provider Identifier
1194724708
Registry record updated Sep 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2013-0027 Issued in NM
Practice address
600 NM Hwy 195
Ste a
Elephant Butte, NM 87935-0449
Phone
(575) 744-4872
Fax
(575) 548-7290
NPI assigned
Jul 15, 2005
Last updated
Sep 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2013-0027 NM Primary
Physician Assistant 363A00000X IL

Addresses

Primary practice location

600 NM Hwy 195
Ste a
Elephant Butte, NM 87935-0449

Mailing address

PO Box 449
Elephant Butte, NM 87935-0449
Phone (575) 267-3280

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
I20130923000337 NM Practitioner - Physician Assistant 7416947528 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

600 NM Hwy 195
Elephant Butte, NM 87935-0449
Phone (575) 744-4872

PO Box
Elephant Butte, NM 87935

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA2013-0027NMMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ben Archer Health Center CurrentSince Jul 15, 2013 Accepting new patients
Ben Archer Health Center CurrentSince Jul 15, 2013 Accepting new patients
Crossroads Physicians Corp Physician Assistant Past Accepting new patients
Crossroads Physician Corporation Physician Assistant Past Accepting new patients

Locations

1501 10th St
Alamogordo, NM 88310
Phone (505) 443-8133

1960 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-7662

Interoperability endpoints

  • Direct secure messaging: compassioncareclinicpc.dallslipscomb@147317.advancedmd-direct.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Compassion Care Clinic PCElephant Butte, NM, CCN 323860 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2024
Apr 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 5

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": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600819200000",
    "number": "1194724708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 449",
            "city": "ELEPHANT BUTTE",
            "state": "NM",
            "postal_code": "879350449",
            "telephone_number": "575-267-3280",
            "fax_number": "575-267-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 NM HWY 195",
            "address_2": "STE A",
            "city": "ELEPHANT BUTTE",
            "state": "NM",
            "postal_code": "879350449",
            "telephone_number": "575-744-4872",
            "fax_number": "575-548-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPSCOMB",
        "first_name": "DALLAS",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2013-0027",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elephant Butte, NM

Sources for this page

Verify at the official NPI Registry.