Active NPI
Kenneth Gilman, PHD
- Clinical Psychologist
- Albuquerque, NM
National Provider Identifier
1265500151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0837
- Practice address
- 5219 Guadalupe TRL NW
Albuquerque, NM 87107-3346 - Phone
- (505) 980-1865
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0837 | NM | Primary |
Addresses
Primary practice location
5219 Guadalupe TRL NW
Albuquerque, NM 87107-3346
Mailing address
4801 Lang Ave NE
Suite 110
Albuquerque, NM 87109-4475
Phone (505) 980-1865
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46181334 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 505 Diagnostics LLC | Clinical | Current | Accepting new patients |
Locations
4225 Montgomery Blvd NE
Albuquerque, NM 87109
Phone (505) 366-3635
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1265500151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 LANG AVE NE",
"address_2": "SUITE 110",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871094475",
"telephone_number": "505-980-1865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5219 GUADALUPE TRL NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871073346",
"telephone_number": "505-980-1865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILMAN",
"first_name": "KENNETH",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NM",
"license": "0837",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "46181334",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.