Active NPI
Vance Edward Zachary, M.D.
- Family Medicine Physician
- Albuquerque, NM
National Provider Identifier
1295796480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD2015-0091
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 401311YR41 | Other | NM | MEDICARE NUMBER |
| 25156772 | Medicaid | NM |
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
| License | State | Type | Specialty |
|---|---|---|---|
| MD2015-0091 | NM | MD | Family Medicine Physician |
| G7610 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Medicine Associates | Family Medicine | Past | 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.
-
- Family Medicine Physician
- San Antonio, TX
- NPI 1245313329
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.