NPIMap

Individual provider Active NPI

Alberto Gonzalez-Villaverde, MD

  • Vascular & Interventional Radiology Physician
  • Albuquerque, NM
National Provider Identifier
1295788479
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
MD2011-0003 Issued in NM
Practice address
4411 The 25 Way NE
Suite 150
Albuquerque, NM 87109-5857
Phone
(505) 332-6900
Fax
(505) 332-6921
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 25014 KY
Vascular & Interventional Radiology Physician 2085R0204X MD2011-0003 NM Primary

Addresses

Primary practice location

4411 The 25 Way NE
Suite 150
Albuquerque, NM 87109-5857

Mailing address

4411 The 25 Way NE
Suite 150
Albuquerque, NM 87109-5857
Phone (505) 332-6900

Other identifiers 1

IdentifierTypeStateIssuer
64250145MedicaidKY

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
MD2011-0003NMMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Cumberland Regional Hospital, LLC Family Medicine Past Accepting new patients
Pco PC Diagnostic Radiology Past Accepting new patients
Bluegrass Radiology Associates Inc Diagnostic Radiology Past Accepting new patients
Advanced Imaging LLC Past Accepting new patients

Organizations & group practices 4

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1295788479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4411 THE 25 WAY NE",
            "address_2": "SUITE 150",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095857",
            "telephone_number": "505-332-6900",
            "fax_number": "505-332-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 THE 25 WAY NE",
            "address_2": "SUITE 150",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095857",
            "telephone_number": "505-332-6900",
            "fax_number": "505-332-6921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ-VILLAVERDE",
        "first_name": "ALBERTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "25014",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NM",
            "license": "MD2011-0003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64250145",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2019; 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.