Individual provider Active NPI

Manuela Gallegos, PAC

  • Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1548457997
Registry record updated Aug 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2007-0025 Issued in NM
Practice address
4100 High Resort Blvd SE
Albuquerque, NM 87124-5901
Phone
(505) 462-8809
Fax
(505) 462-8468
NPI assigned
Oct 1, 2007
Last updated
Aug 31, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2007-0025 NM Primary
Medical Physician Assistant 363AM0700X PA20070025 NM

Addresses

Primary practice location

4100 High Resort Blvd SE
Albuquerque, NM 87124-5901

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770

Other identifiers 1

IdentifierTypeStateIssuer
243873MedicaidNM

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20080117000132 NM Practitioner - Physician Assistant 2163503079 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

2200 W 21St St
Clovis, NM 88101-2011
Phone (505) 769-7577

3630 Las Estancias Dr SW
Albuquerque, NM 87121-5504
Phone (505) 462-7777

3901 Atrisco Dr NW
Albuquerque, NM 87120-1627
Phone (505) 462-7575

4100 High Resort Blvd SE
Rio Rancho, NM 87124-5901
Phone (505) 462-8888

8300 Constitution Ave NE
Albuquerque, NM 87110-7613

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2007-0025NMMDPhysician Assistant
PA20070025NMMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Oct 27, 2014 Accepting new patients
Presbyterian Healthcare Services CurrentSince Oct 27, 2014 Accepting new patients
Presbyterian Healthcare Services Past Accepting new patients

Locations

3436 Isleta Blvd SW
Albuquerque, NM 87105
Phone (505) 462-7777

3630 Las Estancias Dr SW
Albuquerque, NM 87121
Phone (505) 462-7777

3901 Atrisco Dr NW
Albuquerque, NM 87120
Phone (505) 462-7575

4515 Coors Blvd NW
Albuquerque, NM 87120
Phone (505) 596-2200

4588 Paradise Blvd NW
Albuquerque, NM 87114
Phone (505) 923-2070

5901 Harper Dr NE
Albuquerque, NM 87109
Phone (505) 823-8233

6400 Paseo del Norte NE
Albuquerque, NM 87113
Phone (505) 596-2100

8300 Constitution Ave NE
Bldg D
Albuquerque, NM 87110
Phone (505) 291-2200

609 Christopher Dr
Belen, NM 87002
Phone (505) 861-1771

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

4100 High Resort Blvd SE
Rio Rancho, NM 87124
Phone (505) 291-2770

454 Saint Michaels Dr
Santa Fe, NM 87505
Phone (505) 303-5000

4801 Beckner Rd
Santa Fe, NM 87507
Phone (505) 772-1234

Interoperability endpoints

  • Direct secure messaging: mgallegos81005@direct.phs.org

Organizations & group practices 4

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 2

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": "1191196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1548457997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-6770",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 HIGH RESORT BLVD SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871245901",
            "telephone_number": "505-462-8809",
            "fax_number": "505-462-8468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLEGOS",
        "first_name": "MANUELA",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-01",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2007-0025",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "PA20070025",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "243873",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.