Marilyn D Miller-Shultz, CNP
Individual provider Active NPI Nurse Practitioner · T Or C, NM
NPI 1487624474 · NPPES record last updated Jan 11, 2022
Key facts
- NPI
- 1487624474
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- CNP00485 (NM)
- Practice address
- 1960 N Date St
T Or C, NM 87901-3701 - Phone
- (575) 894-7662
- NPI assigned
- Jan 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fallon Tribal Health Center
Practice addresses (Care Compare)
1001 Rio Vista Dr
Fallon, NV 89406-5463
Phone (775) 423-3634
Hospital & facility affiliations
- Banner Churchill Community Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.68 of 100
- Quality
- 82.35
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NM, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040304001120 | NM | Practitioner - Nurse Practitioner | 4284522038 | Reassigns benefits to 2 organizations |
| I20070802000088 | TX | Practitioner - Nurse Practitioner | 4284522038 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fallon Tribal Health Center | Current |
Accepting new patients | |
| Ben Archer Health Center | Current |
Accepting new patients | |
| Ben Archer Health Center | Current |
Accepting new patients | |
| Ben Archer Health Center | Current | Accepting new patients | |
| Presbyterian Healthcare Services | Current |
Accepting new patients | |
| Quantum Healthcare Medical Associates Inc. | Past | Accepting new patients | |
| Lea Emergency Group LLC | Nurse Practitioner | Past | Accepting new patients |
| Roswell Hospital Corporation | Past | Accepting new patients | |
| Presbyterian Healthcare Services | Past | Accepting new patients | |
| Mesa Emergency Group LLC | Nurse Practitioner | Past | Accepting new patients |
| Eddy Emergency Group LLC | Nurse Practitioner | Past | Accepting new patients |
Locations
1501 10th St
Alamogordo, NM 88310
Phone (505) 443-8133
8300 Constitution Ave NE
Bldg D
Albuquerque, NM 87110
Phone (505) 291-2200
2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577
211 Sudderth Dr
Ruidoso, NM 88345
Phone (505) 257-7381
1960 N Date St
Truth Or Consequences, NM 87901
Phone (575) 894-7662
1001 Rio Vista Dr
Fallon, NV 89406
Phone (775) 423-3634
Interoperability endpoints
- mmillershultz66900@direct.phs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | CNP00485 | NM | Yes |
Addresses
Primary practice location
1960 N Date St
T Or C, NM 87901-3701
Mailing address
PO Box 370
Hatch, NM 87937-0370
Phone (575) 266-3280
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R25875 | Other | NM | APN STATE LICENSURE |
Other names
- Marilyn D Miller Shultz
Other providers in T Or C, NM
- Ruth M Legarda
- Elizabeth Lynn Leininger
- Joann Love
- Brandy Kay McKinley
- Allison Mettey
- Richard R. Mireles
- Annette A Miyamoto
- Carol Morrell
- Vishna Peoples
- Matthew Myers Peters
All providers in T Or C, NM · Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.