NPIMap

Organization Active NPI

Greg Baca MD, LLC

  • Psychiatry Physician
  • Los Alamos, NM
National Provider Identifier
1457789125
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD2008-0553 Issued in NM
Legal business name
GREG BACA MD, LLC
Practice address
464 Central Ave
Suite 4
Los Alamos, NM 87544-3350
Phone
(505) 795-5217
NPI assigned
Oct 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

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

Authorized official

Name
Gregory K Baca, M.D.NPI 1922171123
Title
Owner
Phone
(505) 795-5217

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
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X MD2008-0553 NM Primary

Addresses

Primary practice location

464 Central Ave
Suite 4
Los Alamos, NM 87544-3350

Mailing address

112 Grand Canyon Dr
Los Alamos, NM 87544-3423
Phone (505) 795-5217

Other identifiers 1

IdentifierTypeStateIssuer
13252291MedicaidNM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1457789125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 GRAND CANYON DR",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875443423",
            "telephone_number": "505-795-5217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "464 CENTRAL AVE",
            "address_2": "SUITE 4",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875443350",
            "telephone_number": "505-795-5217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREG BACA MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "BACA",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-795-5217",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "MD2008-0553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13252291",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Alamos, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.