Active NPI
Stephen Hubbert, DDS
- Dentist
- Isleta, NM
National Provider Identifier
1285714121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1649
- Practice address
- 01 Sagebrush
Isleta, NM 87022-0000 - Phone
- (505) 869-4863
- Fax
- (505) 869-4881
- NPI assigned
- Oct 16, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 1649 | NM | Primary |
Addresses
Primary practice location
01 Sagebrush
Isleta, NM 87022-0000
Mailing address
PO Box 640
Isleta, NM 87022-0640
Phone (505) 869-4863
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649 | Other | NM | LICENSE |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150112000786 | NM | Order and Referring Only - Dentist | 4385968841 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1649 | NM | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285714121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 640",
"city": "ISLETA",
"state": "NM",
"postal_code": "870220640",
"telephone_number": "505-869-4863",
"fax_number": "505-869-4881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "01 SAGEBRUSH",
"city": "ISLETA",
"state": "NM",
"postal_code": "870220000",
"telephone_number": "505-869-4863",
"fax_number": "505-869-4881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUBBERT",
"first_name": "STEPHEN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "1649",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "1649",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Isleta, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.