Individual provider Active NPI

Jeannett Martinez

  • Family Nurse Practitioner
  • Albuquerque, NM
National Provider Identifier
1629543640
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP-54246 Issued in NM
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, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181215000353 NM Practitioner - Nurse Practitioner 8224373493 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CNP-54246NMMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rehoboth McKinley Christian Health Care Services, Inc CurrentSince May 12, 2020 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 CurrentSince Aug 1, 2021 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

  • FHIR API: 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.

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

Verify at the official NPI Registry.