Southern New Mexico Neurosurgery LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

Legal business name

SOUTHERN NEW MEXICO NEUROSURGERY LLC

Practice address

3850 E Lohman Ave Ste C
Las Cruces, NM 88011-8288

Phone

(575) 522-1974

Fax

(575) 522-5209

NPI assigned

Oct 1, 2007

Last updated

Jun 26, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brett R. Henderson, M.D.NPI 1598818189

Title

President

Phone

(575) 522-1974

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brett R Henderson, M.D.

  • Neurological Surgery Physician
  • Las Cruces, NM
  • NPI 1598818189
  Medicare reassignment NPD Authorized official
• Jill M Freemyer, CNP

  • Nurse Practitioner
  • Las Cruces, NM
  • NPI 1437348208
  Medicare reassignment NPD
• Omar Jan, P.A.

  • Physician Assistant
  • Las Cruces, NM
  • NPI 1376696971
  NPD (past)

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1558558726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13668",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880133668",
            "telephone_number": "575-522-1974",
            "fax_number": "575-522-5209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 E LOHMAN AVE STE C",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118288",
            "telephone_number": "575-522-1974",
            "fax_number": "575-522-5209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN NEW MEXICO NEUROSURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "575-522-1974",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DG08655",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21709751",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NM",
            "identifier": "NM007L05",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern New Mexico Dental Group PC (Hillrise Dental)
• Southern New Mexico Diabetes Outreach
• Southern New Mexico Diagnostics LLC
• Southern New Mexico Family Neurology LLC
• Southern New Mexico Heart and Vascular Group LLC
• Southern New Mexico Psychological Associates PA
• Southwest Air Ambulance
• Southwest Center on Aging
• Southwest Chiropractic Inc
• Southwest Counseling Center

• Neurological Surgery Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Neurological Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.