Jyoti B Ganji, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

06964R Issued in LA

Practice address

80 B Veterans Blvd
Acoma, NM 87034

Phone

(505) 552-5300

Fax

(505) 552-5490

NPI assigned

Oct 4, 2005

Last updated

Nov 23, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Cenla Laser Clinic

  • Surgery Physician
  • Alexandria, LA
  • NPI 1619130002
  NPD (past) Authorized official
• Haaku Health

  • Health Service Clinic/Center
  • San Fidel, NM
  • NPI 1962384438
  NPD (past)

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1255328266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "SAN FIDEL",
            "state": "NM",
            "postal_code": "870490130",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 B VETERANS BLVD",
            "city": "ACOMA",
            "state": "NM",
            "postal_code": "87034",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANJI",
        "first_name": "JYOTI",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "06964R",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KS",
            "license": "22011",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "13972",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1979627",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H3451",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donita Sue Demontiney, PA-C
• Dialysis Clinic Inc.
• Michael Diantonio, MD
• Michelle F Dubuisson, FNP-C
• Shaundine Lea Duncan, RDH
• Phillip Garcia
• Shalyn Leandra Garcia
• Rodney N Gilliland, O.D.
• Shawn P Giorgianni
• Nathan Gonzales

• Surgery Physician in Acoma, NM
• Providers in Acoma, NM by specialty
• Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.