Janet Lee Gorham, APRN-CNP
Individual provider Active NPI Family Nurse Practitioner · Aztec, NM
NPI 1265604557 · NPPES record last updated May 9, 2023
Key facts
- NPI
- 1265604557
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 72100 (NM)
- Practice address
- 120 Llano St
Aztec, NM 87410-2172 - Phone
- (505) 334-9441
- NPI assigned
- Mar 27, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.97 of 100
- Quality
- 79.73
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 78.87
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in TX, MT, CO, WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090608000041 | TX | Practitioner - Nurse Practitioner | 3971674490 | Reassigns benefits to 2 organizations |
| I20211220000864 | MT | Practitioner - Nurse Practitioner | 3971674490 | Reassigns benefits to 1 organization |
| I20230218000178 | CO | Practitioner - Nurse Practitioner | 3971674490 | Reassigns benefits to 1 organization |
| I20230419000275 | WA | Practitioner - Nurse Practitioner | 3971674490 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 161890 | MT | MD | Family Nurse Practitioner |
| 90898 | OK | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bastion Health PC | Family | Current |
Accepting new patients |
| Warm Springs Health and Wellness DHHS IHS Warm Springs Service Unit | Current |
Accepting new patients | |
| Glendive Medical Center, Inc | Current | Accepting new patients | |
| Southwest Health System, Inc. | Current |
Accepting new patients | |
| DHHS PHS Naihs Crownpoint Hospital | Current | Accepting new patients | |
| Glendive Medical Center, Inc | Current |
Accepting new patients | |
| Southwest Health System, Inc. | Current |
Accepting new patients | |
| Pueblo Pintado Clinic | Current | Accepting new patients | |
| Glendive Medical Center, Inc | Current |
Accepting new patients | |
| Thoreau Clinic | Current |
Accepting new patients | |
| Southwest Health System Inc | Current | Accepting new patients | |
| Cherokee Nation | Past |
Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Locations
1311 N Mildred Rd
Cortez, CO 81321
Phone (970) 565-6666
1413 N Mildred Rd
Cortez, CO 81321
Phone (970) 564-1037
202 Prospect Dr
Glendive, MT 59330
Phone (406) 345-3306
6811 S 204th St
Ste 280
Kent, WA 98032
Phone (206) 229-6448
1412 SW 43rd St
Ste 240
Renton, WA 98057
Phone (253) 852-4699
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 90898 | OK | |
| Family Nurse Practitioner | 363LF0000X | 161890 | MT | |
| Family Nurse Practitioner | 363LF0000X | 72100 | NM | Yes |
Addresses
Primary practice location
120 Llano St
Aztec, NM 87410-2172
Mailing address
PO Box 6210
Farmington, NM 87499-6210
Phone (505) 609-2258
Other practice location 1
859 E Melton Dr
Jay, OK 74346-2704
Phone (918) 253-1700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100747570A | Medicaid | OK | |
| 200210930A | Medicaid | OK |
Other providers in Aztec, NM
- Parker Gaughan
- Aimee Aline Geiger
- Amber Gipson
- Suzette Lorraine Gordon
- Margaret Irene Gores
- Crystal Goss
- Summer Graham
- Sara Gutierrez
- Roy Edward Harrington
- Savannah Claire Hazelwood
All providers in Aztec, NM · Family Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.