NPIMap

Organization Active NPI

Revitalized Natural Health Center

  • Acute Care Nurse Practitioner
  • Albuquerque, NM
National Provider Identifier
1205139805
Registry record updated Mar 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R25188 Issued in NM
Legal business name
REVITALIZED NATURAL HEALTH CENTER
Practice address
720 Lamp Post Cir SE
Albuquerque, NM 87123-4115
Phone
(505) 293-1658
Fax
(505) 298-4737
NPI assigned
Dec 21, 2010
Last updated
Mar 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2016

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

Authorized official

Name
Mrs. Philomena E Marcus, CFNP
Title
Owner
Phone
(505) 293-1658

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R25188 NM Primary

Addresses

Primary practice location

720 Lamp Post Cir SE
Albuquerque, NM 87123-4115

Mailing address

720 Lamp Post Cir SE
Albuquerque, NM 87123-4115
Phone (505) 293-1658

Other identifiers 2

IdentifierTypeStateIssuer
NM00RH90OtherNMBCBS OF NM
94108897MedicaidNM

National Provider Directory

National Provider Directory

Locations

1101 Cardenas Dr NE
Ste 105
Albuquerque, NM 87110
Phone (505) 205-3618

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10671/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1292889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458864000000",
    "number": "1205139805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 LAMP POST CIR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871234115",
            "telephone_number": "505-293-1658",
            "fax_number": "505-298-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 LAMP POST CIR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871234115",
            "telephone_number": "505-293-1658",
            "fax_number": "505-298-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZED NATURAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-21",
        "last_updated": "2016-03-25",
        "status": "A",
        "authorized_official_last_name": "MARCUS",
        "authorized_official_first_name": "PHILOMENA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-293-1658",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NM",
            "license": "R25188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NM",
            "identifier": "NM00RH90",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94108897",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.