Manuel C. Archuleta, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

74-117 Issued in NM

Practice address

PMG Isleta
3436 Isleta Blvd SW
Albuquerque, NM 87105

Phone

(505) 462-7777

Fax

(505) 462-7880

NPI assigned

Aug 30, 2006

Last updated

Oct 11, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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.

• Presbyterian Healthcare Services

  dba Presbyterian Medical Group

  • Internal Medicine Physician
  • Albuquerque, NM
  • NPI 1104802354
  Medicare reassignment

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318291200000",
    "number": "1457460776",
    "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 ISLETA",
            "address_2": "3436 ISLETA BLVD SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87105",
            "telephone_number": "505-462-7777",
            "fax_number": "505-462-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARCHULETA",
        "first_name": "MANUEL",
        "middle_name": "C.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2011-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "74-117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeff D Archuleta, ATC/L
• Kimberly Archuleta, CNP
• Larry Archuleta
• Laura Archuleta
• Leslie Jade Archuleta, MD
• Mariah Archuleta
• Matthew Archuleta, PHARM.D
• Megan Archuleta
• Michael M Archuleta, DNP, AGACNP-BC, APRN
• Milena Celannie Archuleta, FNP-BC

• Pediatrics Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Pediatrics Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.