NPIMap

Individual provider Active NPI

William R Dougherty, MD

  • Plastic Surgery Physician
  • Taos, NM
National Provider Identifier
1497842512
Registry record updated Jan 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
MD2010-0793 Issued in NM
Practice address
1331 Maestas Rd
Taos, NM 87571-6268
Phone
(575) 776-7806
Fax
(575) 224-7806
NPI assigned
Oct 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Trauma Surgery Physician 2086S0127X MD38986 TN
Trauma Surgery Physician 2086S0127X MD071147L PA
Trauma Surgery Physician 2086S0127X MD2010-0793 NM
Plastic Surgery Physician 208200000X MD2010-0793 NM Primary

Addresses

Primary practice location

1331 Maestas Rd
Taos, NM 87571-6268

Mailing address

1331 Maestas Rd
Taos, NM 87571-6268
Phone (575) 776-7806

Other identifiers 1

IdentifierTypeStateIssuer
932970OtherMDCAREFIRST MD BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110217000343 NM Practitioner - General SurgeryPractitioner - Plastic and Reconstructive SurgeryPractitioner - Critical Care (Intensivists) 3870559370 Reassigns benefits to 3 organizations
I20221117003492 PA Practitioner - Plastic and Reconstructive Surgery 3870559370 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists), Plastic and Reconstructive Surgery
Education
University of Southern California Keck School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Taos Whole Health Integrative Care, LLC.Group PAC ID 0446523997, 6 clinicians
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

1331 Maestas Rd
Taos, NM 87571-6268
Phone (575) 776-7806

675 Baltimore Dr
Wilkes Barre, PA 18702-7900
Phone (570) 826-7300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Mastectomy28
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision11
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD38986TNMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Taos Professional Services,LLC CurrentSince Dec 1, 2018 Accepting new patients
Geisinger Clinic CurrentSince Oct 17, 2022 Accepting new patients
Geisinger Clinic CurrentSince Oct 17, 2022 Accepting new patients
Taos Professional Services, LLC CurrentSince Dec 1, 2018 Accepting new patients
Taos Whole Health Integrative Care, LLC CurrentSince Jan 25, 2023 Accepting new patients
Taos Health Systems Inc Holy Cross Hospital CurrentSince Jul 13, 2019 Accepting new patients
Geisinger Clinic Current Accepting new patients
Lehigh Valley Physician Group Plastic Surgery Past Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

1331 Maestas Rd
Taos, NM 87571
Phone (505) 758-1216

1397 Weimer Rd
Taos, NM 87571
Phone (575) 751-5746

100 N Academy Ave
Danville, PA 17822

675 Baltimore Dr
Wilkes Barre, PA 18702
Phone (570) 808-5757

Interoperability endpoints

  • Direct secure messaging: william.dougherty.1@17440.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/17440/brand/1/csg/1/fhir/r4

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 32

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1497842512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 MAESTAS RD",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716268",
            "telephone_number": "575-776-7806",
            "fax_number": "575-224-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 MAESTAS RD",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716268",
            "telephone_number": "575-776-7806",
            "fax_number": "575-224-7806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "WILLIAM",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-09",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "TN",
            "license": "MD38986",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "PA",
            "license": "MD071147L",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "NM",
            "license": "MD2010-0793",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NM",
            "license": "MD2010-0793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD BCBS",
            "identifier": "932970",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taos, NM

Sources for this page

Verify at the official NPI Registry.