Active NPI
Gerald L Watchman, LADAC
- Addiction (Substance Use Disorder) Counselor
- Gallup, NM
National Provider Identifier
1215068200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 73141
- Practice address
- 650 Vanden Bosch Pkwy
B
Gallup, NM 87301-5508 - Phone
- (505) 726-6900
- Fax
- (505) 722-6192
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 73141 | NM | Primary |
Addresses
Primary practice location
650 Vanden Bosch Pkwy
B
Gallup, NM 87301-5508
Mailing address
1901 Redrock Dr
PFS Dept
Gallup, NM 87301-5683
Phone (505) 863-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VNM00011OT | Other | NM | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73141 | NM | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215068200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 REDROCK DR",
"address_2": "PFS DEPT",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015683",
"telephone_number": "505-863-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 VANDEN BOSCH PKWY",
"address_2": "B",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015508",
"telephone_number": "505-726-6900",
"fax_number": "505-722-6192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATCHMAN",
"first_name": "GERALD",
"middle_name": "L",
"credential": "LADAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "73141",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "VNM00011OT",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.