Kristina Marie Chongsiriwatana, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

2004-0276 Issued in NM

Practice address

4640 Jefferson LN NE
Albuquerque, NM 87109-2116

Phone

(505) 843-6168

Fax

(505) 792-1978

NPI assigned

Feb 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kchongsiriwatana7368@ahs.direct-ci.com

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.

• Womens Specialists of New Mexico LTD

  • Obstetrics & Gynecology Physician
  • Albuquerque, NM
  • NPI 1063418960
  Medicare reassignment NPD

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1508907452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6320 RIVERSIDE PLAZA LN NW STE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871201710",
            "telephone_number": "505-843-6168",
            "fax_number": "505-792-1978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4640 JEFFERSON LN NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871092116",
            "telephone_number": "505-843-6168",
            "fax_number": "505-792-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHONGSIRIWATANA",
        "first_name": "KRISTINA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NM",
            "license": "2004-0276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "86080261",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Choice Hospice New Mexico, LLC
• Choice Recovery Path LLC
• Choices Inc.
• Karen Christine Chong, MD
• Krisna Chongsiriwatana, M.D.
• Nararat Chongsiriwatana, MD
• Prajna Chopra, M.D., RDMS
• Zachary Chota
• Hui Hsia Chou
• Veena Devi Sairam Choudary, RPH

• Obstetrics & Gynecology Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Obstetrics & Gynecology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; 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.