Individual provider Active NPI

Ping Pan, M.D.

  • Surgery Physician
  • Albuquerque, NM
National Provider Identifier
1508155540
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD2017-0564 Issued in NM
Practice address
303 Roma Ave NW
Albuquerque, NM 87102-2251
Phone
(214) 402-9398
NPI assigned
Mar 30, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD2017-0564 NM Primary

Addresses

Primary practice location

303 Roma Ave NW
Albuquerque, NM 87102-2251

Mailing address

11704 Richfield Ave NE
Albuquerque, NM 87122-4025
Phone (214) 402-9398

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230605002430 CO Practitioner - General Surgery 9133367238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1600 N Grand Ave
Pueblo, CO 81003-2757

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux14
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Multi-Specialty Current Accepting new patients
Poudre Valley Medical Group, LLC Multi-Specialty CurrentSince Jun 1, 2025 Accepting new patients
Parkview Medical Center, Inc. Past Accepting new patients

Locations

1600 N Grand Ave
Ste 540
Pueblo, CO 81003
Phone (719) 545-8240

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1301443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508155540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11704 RICHFIELD AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871224025",
            "telephone_number": "214-402-9398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 ROMA AVE NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022251",
            "telephone_number": "214-402-9398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAN",
        "first_name": "PING",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NM",
            "license": "MD2017-0564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.