NPIMap

Organization Active NPI

Pangea Medical LLC

  • Psychiatry Physician
  • Roswell, NM
National Provider Identifier
1255786703
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD2011-0547 Issued in NM
Legal business name
PANGEA MEDICAL LLC
Practice address
405 W Country Club Rd
Roswell, NM 88201-5209
Phone
(575) 624-2095
Fax
(575) 208-0780
NPI assigned
May 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Authorized official

Name
Dr. Steven R Black, MDNPI 1578546438
Title
Managing Member
Phone
(575) 624-2095

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MD2011-0547 NM
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X MD2011-0547 NM Primary

Addresses

Primary practice location

405 W Country Club Rd
Roswell, NM 88201-5209

Mailing address

PO Box 8244
Roswell, NM 88202-8244
Phone (575) 624-2095

Other names 1

  • Pangea Medical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161227000266 NM Part B Supplier - Clinic/Group Practice 0042591471 Receives reassigned benefits from 2 practitioners
Practice locations: Roswell, NM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1255786703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8244",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882028244",
            "telephone_number": "575-624-2095",
            "fax_number": "575-208-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W COUNTRY CLUB RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015209",
            "telephone_number": "575-624-2095",
            "fax_number": "575-208-0780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANGEA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "575-624-2095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2011-0547",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "MD2011-0547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pangea Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pangea Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.