Thomas Prendergast, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A716-80 Issued in NM

Practice address

625 Silver SW
Suite a
Albuquerque, NM 87114-5218

Phone

(800) 893-9698

Fax

(337) 371-4738

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Mesa Emergency Group LLC

  • Emergency Medicine Physician
  • Albuquerque, NM
  • NPI 1912000704
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214179200000",
    "number": "1295759108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 661597",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910661597",
            "telephone_number": "626-447-0296",
            "fax_number": "626-447-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 SILVER SW",
            "address_2": "SUITE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145218",
            "telephone_number": "800-893-9698",
            "fax_number": "337-371-4738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENDERGAST",
        "first_name": "THOMAS",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2008-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "A716-80",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX60300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Hearing Center
• Premier Hearing Center LLC
• Premier Hospital Supply Inc (O2 Solutions)
• Premise Health of New Mexico Medical P C (My Health Center At Lowe's New Mexico)
• Premise to Promise LLC
• Jennifer F Prentiss, RPH
• Ronald Edward Prenzel, DMD
• Presbytarian Hospital
• Presbyterian Ear Institute
• Presbyterian Ear Institute

• Emergency Medicine Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Emergency Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.