Carolyn Marie Castillo, M.D.
Individual provider Active NPI Internal Medicine Physician · Albuquerque, NM
NPI 1487764387 · NPPES record last updated Apr 22, 2024
Key facts
- NPI
- 1487764387
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 88-136 (NM)
- Practice address
- 9501 Paseo del Norte NE
Albuquerque, NM 87122-2998 - Phone
- (505) 262-9205
- Fax
- (505) 342-8401
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080507000441 | NM | Practitioner - Internal Medicine |
9234218801 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M9912 | TX | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwest Medical Associates, LLC | Current |
Accepting new patients | |
| Southwest Medical Associates, LLC | Current |
Accepting new patients | |
| Optumcare Endoscopy Center New Mexico, LLC | Past | Accepting new patients | |
| Lovelace Health System, LLC | Past |
Accepting new patients | |
| Lovelace Health System, Inc. | Past | Accepting new patients |
Locations
6701 Jefferson St NE
Albuquerque, NM 87109
Phone (505) 727-0600
715 Martin Luther King Ave NE
Ste 301
Albuquerque, NM 87102
Phone (505) 727-4500
Interoperability endpoints
- ccastillo119219@westdirect.optum.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | M9912 | TX | |
| Internal Medicine Physician | 207R00000X | 88-136 | NM | Yes |
Addresses
Primary practice location
9501 Paseo del Norte NE
Albuquerque, NM 87122-2998
Mailing address
PO Box 26028
Albuquerque, NM 87125-6028
Phone (505) 262-9205
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00011528 | Medicaid | NM |
Other providers in Albuquerque, NM
- Alondra Castillo
- Arianna Castillo
- Audra Castillo
- Brenda L Castillo
- Caroline G Castillo
- Christopher Castillo
- Damian H Castillo
- Daniel Castillo
- David Anthony Castillo
- Diane Theresa Castillo
All providers in Albuquerque, NM · Internal Medicine Physician 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 Apr 22, 2024. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.