Individual provider Active NPI

Manuel Dejesus Zarate Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Gallup, NM
National Provider Identifier
1285122820
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
53324 Issued in NM
Practice address
516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone
(505) 506-6076
NPI assigned
Apr 30, 2018
Last updated
Apr 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 121906 NM
Certified Registered Nurse Anesthetist 367500000X 53324 NM Primary

Addresses

Primary practice location

516 E Nizhoni Blvd
Gallup, NM 87301-5748

Mailing address

455 St. Micheals Drive
Santa Fe, NM 87505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181029000773 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 0042563694 Reassigns benefits to 1 organization
I20210624000021 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 0042563694 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Anesthesia of New Mexico, LLCGroup PAC ID 3476807538, 228 clinicians

Practice addresses (Care Compare)

601 Dr Martin Luther King Jr Ave NE
Lovelace Medical Center
Albuquerque, NM 87102-3619
Phone (505) 727-8000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.34 of 100Reported as group
Quality
77.27
Promoting interoperability
100
Improvement activities
40
Cost
70.54

Merit-based Incentive Payment System (MIPS)

Final score
78.18 of 100Reported as group
Quality
61.12
Improvement activities
40
Cost
81.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
121906NMMDCertified Registered Nurse Anesthetist
53324NMMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Sep 4, 2018 Accepting new patients
Main Street Anesthesia of New Mexico, LLC CurrentSince Apr 15, 2021 Accepting new patients
Southwest Gastroenterology Associates CurrentSince Jan 1, 2024 Accepting new patients

Locations

601 Martin Luther King Ave NE
Albuquerque, NM 87102
Phone (505) 727-8040

7788 Jefferson St NE
Albuquerque, NM 87109
Phone (505) 999-1600

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12517/brand/1/csg/1/fhir/r4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1285122820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 ST. MICHEALS DRIVE",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 E NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015748",
            "telephone_number": "505-506-6076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZARATE",
        "first_name": "MANUEL",
        "middle_name": "DEJESUS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-30",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "121906",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "53324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.