Active NPI
Jeannett Martinez
- Family Nurse Practitioner
- Albuquerque, NM
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- CNP-54246
- Practice address
- 123 Girard Blvd SE
Albuquerque, NM 87106-2227 - Phone
- (505) 726-4407
- Fax
- (505) 557-1941
- NPI assigned
- Oct 5, 2018
- Last updated
- Jul 27, 2021
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP-54246 | NM | Primary |
Addresses
Primary practice location
123 Girard Blvd SE
Albuquerque, NM 87106-2227
Mailing address
123 Girard Blvd SE
Albuquerque, NM 87106-2227
Phone (505) 264-9454
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP-54246 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehoboth McKinley Christian Health Care Services, Inc | Current | Accepting new patients | |
| Rehoboth McKinley Christian Health Care Services, Inc | Current | Accepting new patients | |
| Rehoboth McKinley Christian Health Care Services, Inc. | Current | Accepting new patients | |
| NM Spirit of Wellness LLC | Current | Accepting new patients |
Locations
1900 Red Rock Dr
Gallup, NM 87301
Phone (505) 863-1820
1901 Red Rock Dr
Gallup, NM 87301
Phone (505) 726-6875
2111 College Dr
Gallup, NM 87301
Phone (505) 397-5172
Interoperability endpoints
- https://api.platform.athenahealth.com/19099/brand/1/csg/1/fhir/r4
Organizations & group practices 4
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.
-
- Critical Access Hospital
- Gallup, NM
- NPI 1689784506
-
dba NM Spirit of wellness LC
- Family Medicine Physician
- Albuquerque, NM
- NPI 1982163267
-
- Rural Health Clinic/Center
- Gallup, NM
- NPI 1689779860
-
dba RMCHCS Hospital
- Critical Access Hospital
- Gallup, NM
- NPI 1720084999
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627344000000",
"number": "1629543640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 GIRARD BLVD SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062227",
"telephone_number": "505-264-9454",
"fax_number": "505-557-1941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 GIRARD BLVD SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062227",
"telephone_number": "505-726-4407",
"fax_number": "505-557-1941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "JEANNETT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-05",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NM",
"license": "CNP-54246",
"primary": true
}
],
"identifiers": [],
"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 Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.