Individual provider Active NPI

Debra A Szymanski, DO

  • Pediatrics Physician
  • Albuquerque, NM
National Provider Identifier
1306955638
Registry record updated Aug 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A-1207-03 Issued in NM
Practice address
PMG San Mateo
401 San Mateo Blvd SE
Albuquerque, NM 87108
Phone
(505) 462-7333
Fax
(505) 462-7495
NPI assigned
Aug 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A-1207-03 NM Primary

Addresses

Primary practice location

PMG San Mateo
401 San Mateo Blvd SE
Albuquerque, NM 87108

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5356

Other identifiers 1

IdentifierTypeStateIssuer
45707375MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040518000141 NM Practitioner - Pediatric Medicine 2961492251 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A-1207-03NMMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Pediatrics CurrentSince Jun 20, 2004 Accepting new patients
Presbyterian Healthcare Services CurrentSince Jun 20, 2004 Accepting new patients
Presbyterian Healthcare Services Past Accepting new patients

Locations

401 San Mateo Blvd SE
Albuquerque, NM 87108
Phone (505) 462-7333

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

Interoperability endpoints

  • Direct secure messaging: dszymanski11115@direct.phs.org

Organizations & group practices 3

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218672000000",
    "number": "1306955638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-5356",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PMG SAN MATEO",
            "address_2": "401 SAN MATEO BLVD SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87108",
            "telephone_number": "505-462-7333",
            "fax_number": "505-462-7495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SZYMANSKI",
        "first_name": "DEBRA",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "A-1207-03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45707375",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.