NPIMap

Individual provider Active NPI

Leandro Xavier Centenera, MD

  • General Practice Physician
  • Albuquerque, NM
National Provider Identifier
1194760678
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
MD2004-0079 Issued in NM
Practice address
11516 Pine Top LN NE
Albuquerque, NM 87111-6585
Phone
(505) 389-5053
NPI assigned
Jun 18, 2006
Last updated
Jul 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X MD2004-0079 NM Primary

Addresses

Primary practice location

11516 Pine Top LN NE
Albuquerque, NM 87111-6585

Mailing address

11516 Pine Top LN NE
Albuquerque, NM 87111-6585
Phone (505) 389-5053

Other identifiers 1

IdentifierTypeStateIssuer
0153884MedicaidMT

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
I20040909000571 NM Practitioner - Geriatric MedicinePractitioner - Obstetrics/Gynecology 3375519440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Obstetrics/Gynecology
Education
Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Twilight Physician GroupGroup PAC ID 1456718279, 2 clinicians

Practice addresses (Care Compare)

4273 Montgomery Blvd NE
Suite 110
Albuquerque, NM 87109-6746
Phone (505) 512-1880

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Neuropsychology and Behavioral Health, LLC CurrentSince Mar 13, 2018 Accepting new patients
Twilight Physician Group General Practice CurrentSince May 26, 2023 Accepting new patients

Locations

4273 Montgomery Blvd NE
Ste 110
Albuquerque, NM 87109
Phone (505) 944-7555

5951 Jefferson St NE
Ste C
Albuquerque, NM 87109
Phone (505) 247-4900

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
Luna del Valle HospiceAlbuquerque, NM, CCN 321587 Hospice 5% Or Greater Direct Ownership Interest (50%) Jul 23, 2022

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 3

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 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": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1194760678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11516 PINE TOP LN NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871116585",
            "telephone_number": "505-389-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11516 PINE TOP LN NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871116585",
            "telephone_number": "505-389-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CENTENERA",
        "first_name": "LEANDRO",
        "middle_name": "XAVIER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NM",
            "license": "MD2004-0079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0153884",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.