Individual provider Active NPI

Bobi Jo Lasalle, CNP

  • Nurse Practitioner
  • Alamogordo, NM
National Provider Identifier
1437416567
Registry record updated Apr 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CNP-01961 Issued in NM
Practice address
2150 Highway 54 S
Alamogordo, NM 88310-7330
Phone
(575) 443-8133
Fax
(575) 443-8055
NPI assigned
Apr 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNP-01961 NM Primary

Addresses

Primary practice location

2150 Highway 54 S
Alamogordo, NM 88310-7330

Mailing address

PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280

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
I20120628000552 NM Practitioner - Pediatric Medicine 1759546542 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP-01961NMMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ben Archer Health Center CurrentSince Apr 23, 2012 Accepting new patients
Ben Archer Health Center CurrentSince Apr 23, 2012 Accepting new patients
Ben Archer Health Center Current Accepting new patients

Locations

2150 Highway 54 S
Alamogordo, NM 88310
Phone (575) 443-8133

1600 Thorpe Rd
Las Cruces, NM 88012
Phone (505) 267-3088

1950 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-8057

1960 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-7662

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": "1334275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334275200000",
    "number": "1437416567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "HATCH",
            "state": "NM",
            "postal_code": "879370370",
            "telephone_number": "575-267-3280",
            "fax_number": "575-267-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 HIGHWAY 54 S",
            "city": "ALAMOGORDO",
            "state": "NM",
            "postal_code": "883107330",
            "telephone_number": "575-443-8133",
            "fax_number": "575-443-8055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASALLE",
        "first_name": "BOBI",
        "middle_name": "JO",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-13",
        "last_updated": "2012-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "CNP-01961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alamogordo, NM

Sources for this page

Verify at the official NPI Registry.