Individual provider Active NPI

David John Fitzgerald, MD

  • Pediatrics Physician
  • Albuquerque, NM
National Provider Identifier
1316334246
Registry record updated Jul 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD2018-0766 Issued in NM
Practice address
401 San Mateo Blvd SE
Albuquerque, NM 87108-2921
Phone
(505) 462-7333
Fax
(505) 462-7314
NPI assigned
Apr 17, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2019

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 MD2018-0766 NM Primary

Addresses

Primary practice location

401 San Mateo Blvd SE
Albuquerque, NM 87108-2921

Mailing address

401 San Mateo Blvd SE
Albuquerque, NM 87108-2921
Phone (505) 462-7333

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
I20181107002743 NM Practitioner - Pediatric Medicine 4981917622 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD2018-0766NMMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Nov 12, 2018 Accepting new patients
Presbyterian Healthcare Services Pediatrics CurrentSince Nov 12, 2018 Accepting new patients
Presbyterian Healthcare Services Past Accepting new patients

Locations

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

4588 Paradise Blvd NW
Albuquerque, NM 87114
Phone (505) 923-2070

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

Interoperability endpoints

  • Direct secure messaging: dfitzgerald125885@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": "1429228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562198400000",
    "number": "1316334246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 SAN MATEO BLVD SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871082921",
            "telephone_number": "505-462-7333",
            "fax_number": "505-462-7314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 SAN MATEO BLVD SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871082921",
            "telephone_number": "505-462-7333",
            "fax_number": "505-462-7314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "DAVID",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-17",
        "last_updated": "2019-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "MD2018-0766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.