NPIMap

Organization Active NPI

Nke New Leaf LLC

Doing business as New Leaf Wellness Center

  • Professional Counselor
  • El Paso, TX
National Provider Identifier
1366796724
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
66155 Issued in TX
Legal business name
NKE NEW LEAF LLC
Doing business as
New Leaf Wellness Center
Practice address
10921 Pellicano Dr Ste 110
El Paso, TX 79935
Phone
(915) 313-4114
Fax
(915) 313-4939
NPI assigned
Nov 6, 2012
Last updated
Sep 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Noe Antonio LopezNPI 1467776625
Title
Ceo
Phone
(915) 313-4114

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 66155 TX Primary

Addresses

Primary practice location

10921 Pellicano Dr Ste 110
El Paso, TX 79935

Mailing address

10921 Pellicano Dr Ste 110
El Paso, TX 79935-4604
Phone (915) 313-4114

Other identifiers 2

IdentifierTypeStateIssuer
2915829MedicaidTX
3898868MedicaidTX

Other names 1

  • New Leaf Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230824001129 TX Part B Supplier - Clinic/Group Practice 8426411471 Receives reassigned benefits from 7 practitioners
Practice locations: El Paso, TX

National Provider Directory

National Provider Directory

Locations

10921 Pellicano Dr
Ste 110
El Paso, TX 79935
Phone (915) 313-4114

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1366796724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10921 PELLICANO DR STE 110",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799354604",
            "telephone_number": "915-313-4114",
            "fax_number": "915-313-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10921 PELLICANO DR STE 110",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79935",
            "telephone_number": "915-313-4114",
            "fax_number": "915-313-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NKE NEW LEAF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "NOE",
        "authorized_official_middle_name": "ANTONIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "915-313-4114"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "66155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2915829",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3898868",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Leaf Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.