Individual provider Active NPI

Thomas C. Thompson, PHD

  • Clinical Psychologist
  • Las Cruces, NM
National Provider Identifier
1215004668
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
129 Issued in NM
Practice address
105 W. Griggs Ave.
Las Cruces, NM 88001
Phone
(575) 647-2800
Fax
(575) 647-2898
NPI assigned
Nov 29, 2006
Last updated
Aug 28, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X
Prescribing (Medical) Psychologist 103TP0016X 0003 NM
Clinical Psychologist 103TC0700X 129 NM Primary

Addresses

Primary practice location

105 W. Griggs Ave.
Las Cruces, NM 88001

Mailing address

385 Calle de Alegra
BLDG. a
Las Cruces, NM 88005-3423
Phone (575) 526-1105

Other identifiers 2

IdentifierTypeStateIssuer
468130YRNDOtherNMMEDICARE
61755320MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070514000276 NM Practitioner - Clinical Psychologist 7113024977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inetmed RX2 Inc.Group PAC ID 2062796709, 7 clinicians

Practice addresses (Care Compare)

1635 S Don Roser Dr
Las Cruces, NM 88011-4550
Phone (575) 636-2506

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
129NMMDClinical Psychologist
0003NMMDPrescribing (Medical) Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Inetmed RX2 Inc. Clinical Neuropsychologist CurrentSince Jan 30, 2020 Accepting new patients
La Clinica de Familia, Incorporated Past Accepting new patients

Locations

1635 S Don Roser Dr
Las Cruces, NM 88011
Phone (575) 522-1241

1635 S Don Roser Dr
Ste A
Las Cruces, NM 88011
Phone (575) 635-2506

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535414400000",
    "number": "1215004668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 CALLE DE ALEGRA",
            "address_2": "BLDG. A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053423",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W. GRIGGS AVE.",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "88001",
            "telephone_number": "575-647-2800",
            "fax_number": "575-647-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "THOMAS",
        "middle_name": "C.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2018-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "NM",
            "license": "0003",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NM",
            "license": "129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "468130YRND",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61755320",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.