Individual provider Active NPI

Marlyn A Newby, NP

  • Family Nurse Practitioner
  • Albuquerque, NM
National Provider Identifier
1629091731
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP00016 Issued in NM
Practice address
9109 Montgomery Blvd NE
Albuquerque, NM 87111
Phone
(505) 275-4288
Fax
(505) 275-4203
NPI assigned
Jul 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R06743 NM
Family Nurse Practitioner 363LF0000X CNP00016 NM Primary

Addresses

Primary practice location

9109 Montgomery Blvd NE
Albuquerque, NM 87111

Mailing address

PO Box 26028
Albuquerque, NM 87125-6028

Other identifiers 1

IdentifierTypeStateIssuer
93468MedicaidNM

Other names 1

  • Marlyn Ann Pro Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060320000729 NM Practitioner - Nurse Practitioner 7618984410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optumcare New Mexico LLCGroup PAC ID 9032125810, 69 clinicians

Practice addresses (Care Compare)

13701 Encantado Rd NE
Albuquerque, NM 87123-2275
Phone (505) 237-8700

2121 Juan Tabo Blvd NE
Albuquerque, NM 87112-3307
Phone (505) 237-8800

5150 Journal Ctr Blvd NE
Albuquerque, NM 87109-5900
Phone (505) 262-7000

9101 Montgomery Blvd NE
Albuquerque, NM 87111-2405
Phone (505) 275-4288

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R06743NMMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare New Mexico LLC CurrentSince Jun 1, 2006 Accepting new patients
Optumcare Endoscopy Center New Mexico, LLC Past Accepting new patients

Locations

2901 Transport St SE
Albuquerque, NM 87106
Phone (505) 262-7110

5150 Journal Center Blvd NE
Fl 3
Albuquerque, NM 87109
Phone (505) 262-3212

9101 Montgomery Blvd NE
Albuquerque, NM 87111
Phone (505) 275-4270

601 Martin Luther King Ave NE
Albuquerque, NM 87102
Phone (505) 727-8040

5400 Gibson Blvd SE
Albuquerque, NM 87108
Phone (505) 262-7174

Interoperability endpoints

  • Direct secure messaging: mnewby120819@westdirect.optum.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1629091731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26028",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9109 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87111",
            "telephone_number": "505-275-4288",
            "fax_number": "505-275-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWBY",
        "first_name": "MARLYN",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "R06743",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "CNP00016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93468",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARLYN",
            "last_name": "PRO",
            "middle_name": "ANN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.