505 Diagnostics LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

505 DIAGNOSTICS LLC

Practice address

4225 Montgomery Blvd NE
Albuquerque, NM 87109-1103

Phone

(505) 361-1931

Fax

(505) 521-5147

NPI assigned

Jun 11, 2024

Last updated

Feb 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rebekah Jan Hutchins KhanNPI 1740927953

Title

Ceo/Provider

Phone

(470) 728-9352

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rebekah Jan Hutchins Khan, PHD

  • Professional Counselor
  • Albuquerque, NM
  • NPI 1740927953
  Medicare reassignment Authorized official
• Kenneth Gilman, PHD

  • Clinical Psychologist
  • Albuquerque, NM
  • NPI 1265500151
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1629810486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091103",
            "telephone_number": "505-548-8035",
            "fax_number": "505-581-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 MONTGOMERY BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091103",
            "telephone_number": "505-361-1931",
            "fax_number": "505-521-5147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "505 DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-11",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "HUTCHINS KHAN",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_middle_name": "JAN",
        "authorized_official_title_or_position": "CEO/PROVIDER",
        "authorized_official_telephone_number": "470-728-9352",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Clinical Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.