NPIMap

Individual provider Active NPI

Matthew Bordegaray

  • Vascular & Interventional Radiology Physician
  • Albuquerque, NM
National Provider Identifier
1225353550
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MD2016-0170 Issued in NM
Practice address
601 Dr Martin Luther King Jr Ave NE
Lovelace Medical Center
Albuquerque, NM 87102-3619
Phone
(505) 298-0301
Fax
(505) 554-3302
NPI assigned
Mar 30, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X MD2016-0170 NM Primary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X ME121091 FL

Addresses

Primary practice location

601 Dr Martin Luther King Jr Ave NE
Lovelace Medical Center
Albuquerque, NM 87102-3619

Mailing address

PO Box 4934
Albuquerque, NM 87196-4934
Phone (505) 298-0301

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
I20160725002731 NM Practitioner - Diagnostic Radiology 1850684192 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of New Mexico School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imaging Associates of New Mexico LLCGroup PAC ID 4981970233, 164 clinicians

Practice addresses (Care Compare)

601 Dr Martin Luther King Jr Ave NE
Albuquerque, NM 87102-3619
Phone (505) 225-8476

Hospital & facility affiliations

  • Lovelace Medical Center Hospital, Albuquerque, NM, CCN 320009
  • Lovelace Women'S Hospital Hospital, Albuquerque, NM, CCN 320017
  • Lovelace Westside Hospital Hospital, Albuquerque, NM, CCN 320074
  • Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021
  • Unm Hospital Hospital, Albuquerque, NM, CCN 320001
  • Lovelace Unm Rehabilitation Hospital Inpatient rehabilitation facility, Albuquerque, NM, CCN 323028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME121091FLMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, LLC Family Medicine CurrentSince Dec 10, 2023 Accepting new patients
New Mexico Oncology Hematology Consultants, LTD. CurrentSince May 1, 2018 Accepting new patients
Southwest Medical Associates, LLC Family Medicine CurrentSince Dec 10, 2023 Accepting new patients
Zia Diagnostic Imaging Diagnostic Radiology CurrentSince Jul 25, 2016 Accepting new patients
Imaging Associates of New Mexico LLC Diagnostic Radiology CurrentSince Apr 22, 2024 Accepting new patients

Locations

715 Martin Luther King Ave NE
Ste 301
Albuquerque, NM 87102
Phone (505) 727-4500

10501 Golf Course Rd NW
Albuquerque, NM 87114
Phone (505) 727-2000

601 Martin Luther King Ave NE
Albuquerque, NM 87102
Phone (505) 727-8040

4701 Montgomery Blvd NE
Albuquerque, NM 87109
Phone (505) 727-2000

4901 Lang Ave NE
Albuquerque, NM 87109
Phone (505) 828-3877

2240 College Dr
Gallup, NM 87301
Phone (505) 297-1052

Interoperability endpoints

  • Direct secure messaging: mbordegaray6943@ahs.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1269907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1225353550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4934",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871964934",
            "telephone_number": "505-298-0301",
            "fax_number": "505-554-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 DR MARTIN LUTHER KING JR AVE NE",
            "address_2": "LOVELACE MEDICAL CENTER",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871023619",
            "telephone_number": "505-298-0301",
            "fax_number": "505-554-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEGARAY",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-30",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NM",
            "license": "MD2016-0170",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME121091",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.