NPIMap

Individual provider Active NPI

Amy Elise Lopez, DNP

  • Gerontology Nurse Practitioner
  • Las Cruces, NM
National Provider Identifier
1619323284
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
CNP-02924 Issued in NM
Practice address
4402 Superstition Dr
Las Cruces, NM 88011
Phone
(575) 621-3390
NPI assigned
May 12, 2016
Last updated
Jul 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X CNP-02924 NM
Gerontology Nurse Practitioner 363LG0600X CNP-02924 NM Primary

Addresses

Primary practice location

4402 Superstition Dr
Las Cruces, NM 88011

Mailing address

4402 Superstition Dr
Las Cruces, NM 88011-7503
Phone (575) 621-3390

Other practice location 1

1955 N Valley Dr
Las Cruces, NM 88007-5154
Phone (575) 523-2772

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
I20160921002608 NM Practitioner - Nurse Practitioner 5890082671 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4402 Superstition Dr
Las Cruces, NM 88011-7503
Phone (575) 621-3390

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP-02924NMMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Center on Aging CurrentSince Mar 20, 2018 Accepting new patients
Graceful Aging LLC Adult Health CurrentSince Dec 13, 2018 Accepting new patients
Route 44 Medical Transport Current Accepting new patients
Southwest Emergency Medical Associates of NM PC CurrentSince Dec 13, 2017 Accepting new patients
44 Mobile Labs & Services Gerontology Current Accepting new patients

Locations

1106 Centre Ct
Las Cruces, NM 88011
Phone (575) 532-5455

2450 S Telshor Blvd
Las Cruces, NM 88011
Phone (505) 522-8641

Organizations & group practices 5

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 6

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": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627603200000",
    "number": "1619323284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 SUPERSTITION DR",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880117503",
            "telephone_number": "575-621-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 SUPERSTITION DR",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "88011",
            "telephone_number": "575-621-3390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1955 N Valley Dr",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880075154",
            "country_code": "US",
            "telephone_number": "575-523-2772",
            "fax_number": "575-524-2993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "AMY",
        "middle_name": "ELISE",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-12",
        "last_updated": "2021-07-30",
        "certification_date": "2021-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NM",
            "license": "CNP-02924",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NM",
            "license": "CNP-02924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.