Individual provider Active NPI

Vance Edward Zachary, M.D.

  • Family Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1295796480
Registry record updated Feb 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD2015-0091 Issued in NM
Practice address
4420 Irving Blvd NW
Albuquerque, NM 87114-5915
Phone
(505) 727-6300
Fax
(505) 727-9588
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G7610 TX
Sports Medicine (Family Medicine) Physician 207QS0010X G7610 TX
Family Medicine Physician 207Q00000X MD2015-0091 NM Primary

Addresses

Primary practice location

4420 Irving Blvd NW
Albuquerque, NM 87114-5915

Mailing address

4420 Irving Blvd NW
Albuquerque, NM 87114-5915
Phone (505) 727-6300

Other identifiers 2

IdentifierTypeStateIssuer
401311YR41OtherNMMEDICARE NUMBER
25156772MedicaidNM

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
MD2015-0091NMMDFamily Medicine Physician
G7610TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medicine Associates Family Medicine PastSince Mar 22, 2020 Accepting new patients

Organizations & group practices 1

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454630400000",
    "number": "1295796480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 IRVING BLVD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145915",
            "telephone_number": "505-727-6300",
            "fax_number": "505-727-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 IRVING BLVD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145915",
            "telephone_number": "505-727-6300",
            "fax_number": "505-727-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZACHARY",
        "first_name": "VANCE",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2016-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G7610",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "G7610",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "MD2015-0091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "401311YR41",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25156772",
            "state": "NM"
        }
    ],
    "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 Feb 5, 2016; 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.