NPIMap

Individual provider Active NPI

Antonio J Gonzales IV

  • Family Medicine Physician
  • Santa Fe, NM
National Provider Identifier
1306379664
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD2020-0150 Issued in NM
Practice address
454 St Michaels Dr Ste 200
Santa Fe, NM 87505-7602
Phone
(505) 303-5000
NPI assigned
Apr 4, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD2020-0150 NM Primary

Addresses

Primary practice location

454 St Michaels Dr Ste 200
Santa Fe, NM 87505-7602

Mailing address

PO Box 26666
Albuqeurque, NM 87125-6666
Phone (505) 923-9770

Other identifiers 1

IdentifierTypeStateIssuer
1306379664MedicaidNM

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211209001122 NM Practitioner - Family Practice 2062784614 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New Mexico School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

454 Saint Michaels Dr
Santa Fe, NM 87505-7602
Phone (505) 473-0390

Hospital & facility affiliations

  • Ambercare Home Health Home health agency, Belen, NM, CCN 327123
  • Presbyterian Santa Fe Medical Center Hospital, Santa Fe, NM, CCN 320090
  • Christus St Vincent Regional Medical Center Hospital, Santa Fe, NM, CCN 320002
  • Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021
  • Covenant Medical Center Hospital, Lubbock, TX, CCN 450040

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2020-0150NMMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Medical Services CurrentSince Nov 29, 2021 Accepting new patients
Presbyterian Medical Services Current Accepting new patients
Presbyterian Healthcare Services CurrentSince Mar 1, 2022 Accepting new patients
Presbyterian Healthcare Services Family Medicine CurrentSince Mar 1, 2022 Accepting new patients
Presbyterian Medical Services Family Medicine CurrentSince Nov 29, 2021 Accepting new patients
Presbyterian Healthcare Services PastSince Mar 27, 2022 Accepting new patients

Locations

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

1010 Spruce St
Espanola, NM 87532
Phone (505) 367-0340

454 Saint Michaels Dr
Ste 200
Santa Fe, NM 87505
Phone (505) 303-5000

1422 Paseo de Peralta
Santa Fe, NM 87501
Phone (505) 982-5565

454 Saint Michaels Dr
Santa Fe, NM 87505
Phone (505) 303-5000

Interoperability endpoints

  • Direct secure messaging: agonzales211369@direct.phs.org

Organizations & group practices 6

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647907200000",
    "number": "1306379664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "city": "ALBUQEURQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-9770",
            "fax_number": "505-923-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "454 ST MICHAELS DR STE 200",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057602",
            "telephone_number": "505-303-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "ANTONIO",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-04",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "MD2020-0150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306379664",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "14402 E Sprague Ave",
            "city": "Spokane Valley",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992162167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Fe, NM

Sources for this page

Verify at the official NPI Registry.