Active NPI
Pueblo of Sandia
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Bernalillo, NM
National Provider Identifier
1548588643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Legal business name
- PUEBLO OF SANDIA
- Practice address
- 203 Sandia Day School Road
Bernalillo, NM 87004-7076 - Phone
- (505) 867-4696
- Fax
- (505) 771-5107
- NPI assigned
- May 13, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Gwendolyn Waseta
- Title
- Business Office Manager
- Phone
- (505) 771-5174
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | |||
| Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 332800000X | Primary |
Addresses
Primary practice location
203 Sandia Day School Road
Bernalillo, NM 87004-7076
Mailing address
481 Sandia Loop
Bernalillo, NM 87004-7076
Phone (505) 867-4696
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35922079 | Medicaid | NM |
Other names 1
- Sandia Health Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110321000696 | TX | Part B Supplier - Clinic/Group Practice | 1355524836 |
Receives reassigned benefits from 7 practitioners Practice locations: Bernalillo, NM |
National Provider Directory
National Provider Directory- Tax ID family
- Pueblo of Sandia
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Bernalillo, NM
- NPI 1609116573
Practitioners & affiliated clinicians
Practitioners 7
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": "1273708800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747872000000",
"number": "1548588643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "481 SANDIA LOOP",
"city": "BERNALILLO",
"state": "NM",
"postal_code": "870047076",
"telephone_number": "505-867-4696",
"fax_number": "505-867-4997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 SANDIA DAY SCHOOL ROAD",
"city": "BERNALILLO",
"state": "NM",
"postal_code": "870047076",
"telephone_number": "505-867-4696",
"fax_number": "505-771-5107"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PUEBLO OF SANDIA",
"organizational_subpart": "NO",
"enumeration_date": "2010-05-13",
"last_updated": "2025-05-22",
"certification_date": "2025-05-22",
"status": "A",
"authorized_official_last_name": "WASETA",
"authorized_official_first_name": "GWENDOLYN",
"authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
"authorized_official_telephone_number": "505-771-5174",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "332800000X",
"taxonomy_group": "",
"desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "35922079",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Sandia Health Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Sandia Health Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bernalillo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; 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.