Active NPI
Lisa A Jimenez, MD
- Pediatrics Physician
- Albuquerque, NM
National Provider Identifier
1619902806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 20020168
- Practice address
- 9210 Golf Course Rd NW
Albuquerque, NM 87114-5891 - Phone
- (505) 298-2505
- Fax
- (505) 298-2985
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 20020168 | NM | Primary |
Addresses
Primary practice location
9210 Golf Course Rd NW
Albuquerque, NM 87114-5891
Mailing address
5904 Holly Ave NE
Albuquerque, NM 87113-2472
Phone (505) 298-2505
Other practice location 1
9201 Montgomery Blvd NE
Suite 201
Albuquerque, NM 87111-2468
Phone (505) 298-2505
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15756734 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| After Hours Pediatrics PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba New Mexico Pediatrics
- Pediatrics Physician
- Albuquerque, NM
- NPI 1588730360
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548633600000",
"number": "1619902806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5904 HOLLY AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871132472",
"telephone_number": "505-298-2505",
"fax_number": "505-298-2985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9210 GOLF COURSE RD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871145891",
"telephone_number": "505-298-2505",
"fax_number": "505-298-2985"
}
],
"practiceLocations": [
{
"address_1": "9201 Montgomery Blvd NE",
"address_2": "Suite 201",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871112468",
"country_code": "US",
"telephone_number": "505-298-2505",
"fax_number": "505-298-2985",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JIMENEZ",
"first_name": "LISA",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2019-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NM",
"license": "20020168",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "15756734",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.