NPIMap

Organization Active NPI

Emergency Specialty Services LLC

  • Internal Medicine Physician
  • Santa Fe, NM
National Provider Identifier
1487389136
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
EMERGENCY SPECIALTY SERVICES LLC
Practice address
1650 Hospital Dr Ste 500
Santa Fe, NM 87505-4794
Phone
(505) 670-1976
Fax
(505) 983-7212
NPI assigned
Jul 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Authorized official

Name
Josiah H Child, MDNPI 1194807800
Title
Owner
Phone
(505) 603-5324

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1650 Hospital Dr Ste 500
Santa Fe, NM 87505-4794

Mailing address

1650 Hospital Dr Ste 500
Santa Fe, NM 87505-4794
Phone (505) 670-1976

Other identifiers 1

IdentifierTypeStateIssuer
41588525MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230510000386 NM Part B Supplier - Clinic/Group Practice 0042676470 Receives reassigned benefits from 8 practitioners
Practice locations: Santa Fe, NM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2318072Emergency Specialty Services, LLC1650 Hospital Drive, Suite 500, Santa Fe, NM 87505Certificate of waiverFeb 4, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1658102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1487389136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 HOSPITAL DR STE 500",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054794",
            "telephone_number": "505-670-1976",
            "fax_number": "505-983-7212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 HOSPITAL DR STE 500",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054794",
            "telephone_number": "505-670-1976",
            "fax_number": "505-983-7212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY SPECIALTY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-18",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "CHILD",
        "authorized_official_first_name": "JOSIAH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-603-5324",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41588525",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Fe, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.