Individual provider Active NPI

John M. Mezoff, M.D.

  • Ophthalmology Physician
  • Gallup, NM
National Provider Identifier
1285624296
Registry record updated Apr 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
80-67 Issued in NM
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

Updated by the provider on Apr 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
NM001869OtherNMBC BS OF NM
13649MedicaidNM
180014478OtherNMRRB MEDICARE RAILROAD
239930MedicaidAZ

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

LicenseStateTypeSpecialty
80-67NMMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew 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

  • FHIR API: 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.

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.

Verify at the official NPI Registry.