NPIMap

Organization Active NPI

Srirengam Muralidhasan MD LLC

  • Family Medicine Physician
  • Las Cruces, NM
National Provider Identifier
1215929435
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SRIRENGAM MURALIDHASAN MD LLC
Practice address
1605 El Paseo Rd
Las Cruces, NM 88001-6013
Phone
(575) 527-2600
Fax
(575) 527-5342
NPI assigned
Aug 16, 2005
Reactivated
Nov 10, 2020
Last updated
Jan 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

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

Authorized official

Name
Patricia Quintana
Title
Office Manager
Phone
(575) 405-7665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1605 El Paseo Rd
Las Cruces, NM 88001-6013

Mailing address

1605 El Paseo Rd
Las Cruces, NM 88001-6013
Phone (575) 405-7665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050419001083 NM Part B Supplier - Clinic/Group Practice 8123079274 Receives reassigned benefits from 12 practitioners
Practice locations: Las Cruces, NM

National Provider Directory

National Provider Directory

Locations

1605 El Paseo Rd
Las Cruces, NM 88001
Phone (505) 527-2600

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610409600000",
    "number": "1215929435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 EL PASEO RD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880016013",
            "telephone_number": "575-405-7665",
            "fax_number": "877-539-2504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 EL PASEO RD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880016013",
            "telephone_number": "575-527-2600",
            "fax_number": "575-527-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRIRENGAM MURALIDHASAN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "deactivation_date": "2020-10-02",
        "reactivation_date": "2020-11-10",
        "status": "A",
        "authorized_official_last_name": "QUINTANA",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "575-405-7665"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.