NPIMap

Individual provider Active NPI

Trent Lee Proffitt, M.D.

  • Vascular Surgery Physician
  • Albuquerque, NM
National Provider Identifier
1578513396
Registry record updated Aug 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD2015-0422 Issued in NM
Practice address
502 Elm St NE
Albuquerque, NM 87102-2512
Phone
(505) 841-1000
Fax
(505) 843-2592
NPI assigned
May 11, 2006
Last updated
Aug 6, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X L3442 TX
Vascular Surgery Physician 2086S0129X L3442 TX
Vascular Surgery Physician 2086S0129X MD2015-0422 NM Primary

Addresses

Primary practice location

502 Elm St NE
Albuquerque, NM 87102-2512

Mailing address

502 Elm St NE
Albuquerque, NM 87102-2512
Phone (505) 841-1000

Other identifiers 2

IdentifierTypeStateIssuer
157817101MedicaidTX
8J3515OtherTXBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150917002539 NM Practitioner - Vascular Surgery 4789635053 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southwest Medical Associates, LLCGroup PAC ID 7214831114, 326 clinicians

Practice addresses (Care Compare)

502 Elm St NE
Albuquerque, NM 87102-2512
Phone (505) 841-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal14
Leg revascularization (restoring blood flow)48
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD2015-0422NMMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, LLC CurrentSince May 5, 2019 Accepting new patients
St. Vincent Hospital CurrentSince Mar 1, 2025 Accepting new patients
Southwest Medical Associates, LLC CurrentSince May 5, 2019 Accepting new patients
St Vincent Hospital Current Accepting new patients
North Dallas Surgical Specialists, PA Surgery Past Accepting new patients

Locations

502 Elm St NE
Albuquerque, NM 87102

715 Martin Luther King Ave NE
Ste 301
Albuquerque, NM 87102
Phone (505) 727-4500

455 Saint Michaels Dr
Santa Fe, NM 87505
Phone (505) 913-3361

Interoperability endpoints

  • Direct secure messaging: tproffitt10421@ahs.direct-ci.com

Organizations & group practices 6

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 4

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438819200000",
    "number": "1578513396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 ELM ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022512",
            "telephone_number": "505-841-1000",
            "fax_number": "505-843-2956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 ELM ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871022512",
            "telephone_number": "505-841-1000",
            "fax_number": "505-843-2592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFFITT",
        "first_name": "TRENT",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2015-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "L3442",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "TX",
            "license": "L3442",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NM",
            "license": "MD2015-0422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157817101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8J3515",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.