Shane Brock, CNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

CNP01132/R46618 Issued in NM

Practice address

1635 S Don Roser Dr
Las Cruces VA Cboc
Las Cruces, NM 88011-4550

Phone

(575) 522-1241

NPI assigned

Oct 16, 2008

Last updated

Aug 7, 2015By 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

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

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.

• Las Cruces Physician Services LLC

  • Orthopaedic Surgery Physician
  • Las Cruces, NM
  • NPI 1215079678
  NPD (past)
• New Mexico Vein Treatment Center LLC

  • Surgery Physician
  • Las Cruces, NM
  • NPI 1336182021
  NPD (past)
• Southern New Mexico Diagnostics LLC

  • Mobile Radiology Clinic/Center
  • Las Cruces, NM
  • NPI 1730476748
  NPD (past)

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438905600000",
    "number": "1487806808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 S DON ROSER DR",
            "address_2": "LAS CRUCES VA CBOC",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114550",
            "telephone_number": "575-522-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 S DON ROSER DR",
            "address_2": "LAS CRUCES VA CBOC",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114550",
            "telephone_number": "575-522-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "SHANE",
        "name_prefix": "Mr.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-16",
        "last_updated": "2015-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NM",
            "license": "CNP01132/R46618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clark F Brinton, DMD
• Ramon Briones
• Jenny Brito
• Alivia Britton
• Grace G Brock, M.S., CCC-SLP
• Renata Brodsky, DO
• Wynne E. Broms, PH.D.
• Karma Bromwell
• Melinda Brooks, NP-C
• Cynthia Broughton, OT

• Primary Care Nurse Practitioner in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Primary Care Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; 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.