NPIMap

Individual provider Active NPI

Constantine Chidiebube Chima, MD

  • Internal Medicine Physician
  • Gallup, NM
National Provider Identifier
1245891316
Registry record updated Aug 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD2023-1278 Issued in NM
Practice address
1551 S Second St
Gallup, NM 87301-5881
Phone
(505) 863-7993
NPI assigned
Jun 27, 2019
Last updated
Aug 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X MD2023-1278 NM Primary

Addresses

Primary practice location

1551 S Second St
Gallup, NM 87301-5881

Mailing address

1551 S Second St
Gallup, NM 87301-5881
Phone (505) 863-7993

Other practice location 1

1 Baylor Plz
Houston, TX 77030-3498
Phone (713) 798-4951

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
I20240604001414 NM Practitioner - Internal Medicine 2668707043 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
High Desert Nephrology Associates PLLCGroup PAC ID 5092877696, 7 clinicians
Rehoboth McKinley Christian Health Care Services, Inc.Group PAC ID 1759293855, shared by 3 NPIs, 31 clinicians

Practice addresses (Care Compare)

1551 S 2ND St
Gallup, NM 87301-5881
Phone (505) 863-7993

1801 Red Rock Dr
Gallup, NM 87301-5655
Phone (505) 863-7993

1901 Red Rock Dr
Gallup, NM 87301-5683
Phone (505) 863-7000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
High Desert Nephrology Associates PLLC CurrentSince Apr 23, 2024 Accepting new patients
Rehoboth McKinley Christian Health Care Services, Inc Family Medicine CurrentSince Apr 23, 2024 Accepting new patients
Rehoboth McKinley Christian Health Care Services, Inc CurrentSince Apr 23, 2024 Accepting new patients
Rehoboth McKinley Christian Health Care Services, Inc. Current Accepting new patients

Locations

1551 S Second St
Gallup, NM 87301
Phone (505) 542-0090

1801 Red Rock Dr
Gallup, NM 87301
Phone (505) 863-7933

1901 Red Rock Dr
Gallup, NM 87301
Phone (505) 726-6875

Organizations & group practices 4

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 4

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": "1561593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724457600000",
    "number": "1245891316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 S SECOND ST",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015881",
            "telephone_number": "505-863-7993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 S SECOND ST",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015881",
            "telephone_number": "505-863-7993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Baylor Plz",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303498",
            "country_code": "US",
            "telephone_number": "713-798-4951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHIMA",
        "first_name": "CONSTANTINE",
        "middle_name": "CHIDIEBUBE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-27",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2023-1278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

Verify at the official NPI Registry.