Shiney Nattakom, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

20050080 Issued in NM

Practice address

166 Roadrunner Pkwy
Suite 1B
Las Cruces, NM 88011-7044

Phone

(575) 522-2222

Fax

(575) 521-3216

NPI assigned

Sep 2, 2005

Last updated

Jul 19, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

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

Specialty

Internal Medicine

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Internal Medicine Doctors of Las Cruces

  • Internal Medicine Physician
  • Las Cruces, NM
  • NPI 1518088392
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1396739579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1560",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880041560",
            "telephone_number": "505-647-8366",
            "fax_number": "505-647-8381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 ROADRUNNER PKWY",
            "address_2": "SUITE 1B",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880117044",
            "telephone_number": "575-522-2222",
            "fax_number": "575-521-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NATTAKOM",
        "first_name": "SHINEY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-02",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "20050080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "NM009935",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "850483184",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRESBYTERIAN",
            "identifier": "72676",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50904566",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "110232565",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Leigh Nasuti, MS, BCBA
• Analyssia Natera
• National Orthodontix Management, PLLC (SUN Orthodontix of Las Cruces PLLC)
• National Vision, Inc.
• Nationwide Hearing Services, Inc.
• Thomas V Nattakom, MD
• Nava Behavioral Health
• Nava Behavioral Health LLC (Nava Behavioral Health)
• Nava Counseling Services, LLC
• Nava Drug & Alcohol (Nava Counseling Services)

• Internal Medicine Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Internal Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.