Individual provider Active NPI

Justin Joseph Sommer, M.D.

  • Pediatrics Physician
  • Albuquerque, NM
National Provider Identifier
1275876559
Registry record updated Feb 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD2016-0491 Issued in NM
Practice address
Msc10 5590
1 University of New Mexico
Albuquerque, NM 87131-0001
Phone
(505) 272-2345
Fax
(505) 272-6845
NPI assigned
Apr 4, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 1275876559 NM
Pediatrics Physician 208000000X MD2016-0491 NM Primary

Addresses

Primary practice location

Msc10 5590
1 University of New Mexico
Albuquerque, NM 87131-0001

Mailing address

Msc10 5590
1 University of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-2345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161005000733 NM Practitioner - Pediatric Medicine 2769618891 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2016-0491NMMDPediatrics Physician
1275876559NMMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Pediatrics CurrentSince Jul 24, 2017 Accepting new patients
Presbyterian Healthcare Services CurrentSince Jul 24, 2017 Accepting new patients

Locations

1100 Central Ave SE
Albuquerque, NM 87106
Phone (505) 724-6124

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

Interoperability endpoints

  • Direct secure messaging: jsommer108263@direct.phs.org

Organizations & group practices 2

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": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487116800000",
    "number": "1275876559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MSC10 5590",
            "address_2": "1 UNIVERSITY OF NEW MEXICO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871310001",
            "telephone_number": "505-272-2345",
            "fax_number": "505-272-6845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MSC10 5590",
            "address_2": "1 UNIVERSITY OF NEW MEXICO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871310001",
            "telephone_number": "505-272-2345",
            "fax_number": "505-272-6845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOMMER",
        "first_name": "JUSTIN",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-04",
        "last_updated": "2017-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": "1275876559",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "MD2016-0491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.