NPIMap

Organization Active NPI

Four Corners Radiology Associates PC

  • Diagnostic Radiology Physician
  • Farmington, NM
National Provider Identifier
1265475230
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
FOUR CORNERS RADIOLOGY ASSOCIATES PC
Practice address
801 W. Maple
Farmington, NM 87401
Phone
(505) 325-1572
NPI assigned
Jun 14, 2006
Last updated
Jun 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
Mrs. Danyle Conner
Title
Office Manager
Phone
(505) 325-1572

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

801 W. Maple
Farmington, NM 87401

Mailing address

PO Box 2019
Farmington, NM 87499-2019
Phone (505) 325-1572

Other identifiers 1

IdentifierTypeStateIssuer
44016MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, DE, LA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040521001126 NM Part B Supplier - Clinic/Group Practice 7214928746 Receives reassigned benefits from 10 practitioners
Practice locations: Farmington, NM
O20241031003000 DE Part B Supplier - Clinic/Group Practice 7214928746 Receives reassigned benefits from 1 practitioner
Practice locations: Milton, DE
O20250101000092 LA Part B Supplier - Clinic/Group Practice 7214928746 Receives reassigned benefits from 1 practitioner
Practice locations: Mandeville, LA

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-four

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1265475230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2019",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874992019",
            "telephone_number": "505-325-1572",
            "fax_number": "505-327-4887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W. MAPLE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-325-1572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR CORNERS RADIOLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "CONNER",
        "authorized_official_first_name": "DANYLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-325-1572",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44016",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.