Active NPI
John M. Mezoff, M.D.
- Ophthalmology Physician
- Gallup, NM
National Provider Identifier
1285624296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 80-67
- Practice address
- 231 Nizhoni Blvd
Gallup, NM 87301-5792 - Phone
- (505) 722-2268
- Fax
- (505) 863-2874
- NPI assigned
- Oct 21, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 80-67 | NM | Primary |
Addresses
Primary practice location
231 Nizhoni Blvd
Gallup, NM 87301-5792
Mailing address
8801 Horizon Blvd NE
Suite 360
Albuquerque, NM 87113-1533
Phone (505) 828-4923
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM001869 | Other | NM | BC BS OF NM |
| 13649 | Medicaid | NM | |
| 180014478 | Other | NM | RRB MEDICARE RAILROAD |
| 239930 | Medicaid | AZ |
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80-67 | NM | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Associates of New Mexico LTD | Ophthalmology | Past | Accepting new patients |
| Eye Associates of New Mexico LTD | Ophthalmology | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
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.
-
- Ophthalmology Physician
- Gallup, NM
- NPI 1063559961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209081600000",
"number": "1285624296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8801 HORIZON BLVD NE",
"address_2": "SUITE 360",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871131533",
"telephone_number": "505-828-4923",
"fax_number": "505-213-0103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "231 NIZHONI BLVD",
"city": "GALLUP",
"state": "NM",
"postal_code": "873015792",
"telephone_number": "505-722-2268",
"fax_number": "505-863-2874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEZOFF",
"first_name": "JOHN",
"middle_name": "M.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-21",
"last_updated": "2008-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NM",
"license": "80-67",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS OF NM",
"identifier": "NM001869",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "13649",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RRB MEDICARE RAILROAD",
"identifier": "180014478",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "239930",
"state": "AZ"
}
],
"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 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.