Individual provider Active NPI

Jessie Marie Surla, DNP, BC- FNP

  • Family Nurse Practitioner
  • Roswell, NM
National Provider Identifier
1245656479
Registry record updated Oct 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP-02365 Issued in NM
Practice address
350 W Country Club Rd Ste 201
Roswell, NM 88201-5221
Phone
(575) 624-4651
Fax
(575) 624-4875
NPI assigned
Mar 12, 2014
Last updated
Oct 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X CNP-02365 NM Primary

Addresses

Primary practice location

350 W Country Club Rd Ste 201
Roswell, NM 88201-5221

Mailing address

350 W Country Club Rd Ste 201
Roswell, NM 88201-5221
Phone (575) 624-4651

Other identifiers 1

IdentifierTypeStateIssuer
07276800MedicaidNM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jessie.surla.1@1610.direct.athenahealth.com

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140506000810 NM Practitioner - Nurse Practitioner 6507099165 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Roswell Clinic CorpGroup PAC ID 9436062759, 29 clinicians

Practice addresses (Care Compare)

350 W Country Club Rd
Roswell, NM 88201-5221

350 W Country Club Rd
101 Agave Senior Care and Wellness
Roswell, NM 88201-5222
Phone (575) 624-5622

405 W Country Club Rd
Roswell, NM 88201-5209
Phone (575) 622-8170

601 W Country Club Rd
Suite 101
Roswell, NM 88201-5227
Phone (575) 622-8170

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP-02365NMMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Roswell Clinic Corp CurrentSince Aug 1, 2016 Accepting new patients
Roswell Clinic Corp CurrentSince Aug 1, 2016 Accepting new patients

Locations

350 W Country Club Rd
Ste 101
Roswell, NM 88201
Phone (575) 622-1841

350 W Country Club Rd
Ste 201
Roswell, NM 88201
Phone (575) 622-1841

601 W Country Club Rd
Ste 101
Roswell, NM 88201
Phone (575) 622-8170

Interoperability endpoints

  • Direct secure messaging: jessie.surla.1@1610.direct.athenahealth.com

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.

Hospital & facility affiliations 6

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": "1394582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792368000000",
    "number": "1245656479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W COUNTRY CLUB RD STE 201",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015221",
            "telephone_number": "575-624-4651",
            "fax_number": "575-624-4875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W COUNTRY CLUB RD STE 201",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015221",
            "telephone_number": "575-624-4651",
            "fax_number": "575-624-4875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURLA",
        "first_name": "JESSIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DNP, BC- FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-12",
        "last_updated": "2026-10-19",
        "certification_date": "2026-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP-02365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07276800",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessie.surla.1@1610.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct Address",
            "address_1": "350 W Country Club Rd",
            "address_2": "Suite# 105",
            "city": "Roswell",
            "state": "NM",
            "country_code": "US",
            "postal_code": "882015205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

Verify at the official NPI Registry.