NPIMap

Organization Active NPI

Rio Grande Dermatology, PC

  • Dermatology Physician
  • Albuquerque, NM
National Provider Identifier
1497910848
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
20020450 Issued in NM
Legal business name
RIO GRANDE DERMATOLOGY, PC
Practice address
4545 Alameda Blvd NE
Suite G
Albuquerque, NM 87113-1591
Phone
(505) 896-2900
Fax
(505) 938-4198
NPI assigned
Jul 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

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

Authorized official

Name
Ms. Francine O Montano
Title
Practice Manager
Phone
(505) 896-2900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 20020450 NM Primary
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X 20050405 NM

Addresses

Primary practice location

4545 Alameda Blvd NE
Suite G
Albuquerque, NM 87113-1591

Mailing address

4545 Alameda Blvd NE
Suite G
Albuquerque, NM 87113-1591
Phone (505) 896-2900

Other identifiers 2

IdentifierTypeStateIssuer
47235306MedicaidNM
76659755MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090116000108 NM Part B Supplier - Clinic/Group Practice 4082777008 Receives reassigned benefits from 11 practitioners
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory

Locations

4545 Alameda Blvd NE
Ste G
Albuquerque, NM 87113
Phone (505) 896-2900

4505 Alameda Blvd NE
Albuquerque, NM 87113
Phone (505) 896-2900

Practitioners & affiliated clinicians

Practitioners 11

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": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423094400000",
    "number": "1497910848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 ALAMEDA BLVD NE",
            "address_2": "SUITE G",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871131591",
            "telephone_number": "505-896-2900",
            "fax_number": "505-938-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 ALAMEDA BLVD NE",
            "address_2": "SUITE G",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871131591",
            "telephone_number": "505-896-2900",
            "fax_number": "505-938-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIO GRANDE DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-25",
        "last_updated": "2015-02-05",
        "status": "A",
        "authorized_official_last_name": "MONTANO",
        "authorized_official_first_name": "FRANCINE",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "505-896-2900",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NM",
            "license": "20020450",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "NM",
            "license": "20050405",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47235306",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76659755",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.