Noelle Baroody, PA-C, DOM
Individual provider Active NPI Surgical Physician Assistant · Grants, NM
NPI 1639580749 · NPPES record last updated Apr 14, 2025
Key facts
- NPI
- 1639580749
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- PA2022-0139 (NM)
- Practice address
- 1423 E Roosevelt Ave
Grants, NM 87020 - Phone
- (505) 287-6500
- Fax
- (505) 287-5393
- NPI assigned
- May 12, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230516000546 | NM | Practitioner - Physician Assistant | 6305210261 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1140 | NM | MD | Acupuncturist |
| PA2022-0139 | NM | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cibola General Hospital Corporation | Current |
Accepting new patients | |
| Modern Wellness LLC | Acupuncturist | Current | Accepting new patients |
Locations
3908 Juan Tabo Blvd NE
Albuquerque, NM 87111
Phone (505) 271-9900
1423 E Roosevelt Ave
Grants, NM 87020
Phone (505) 287-6500
1016 E Roosevelt Ave
Grants, NM 87020
Phone (505) 287-4446
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 1140 | NM | |
| Surgical Physician Assistant | 363AS0400X | PA2022-0139 | NM | Yes |
Addresses
Primary practice location
1423 E Roosevelt Ave
Grants, NM 87020
Mailing address
1423 E Roosevelt Ave
Grants, NM 87020-2245
Phone (505) 287-6500
Other practice location 1
1016 E Roosevelt Ave
Grants, NM 87020-2118
Phone (505) 287-6500
Other providers in Grants, NM
- H N Augenstein
- Amanda Jo Baca
- Lita C Bailly
- Alicia Renee Balok
- Jeremy Michael Barnes
- Tamara Bennett
- Shanelle Amber Benton
- Robin Simon Berrin
- Bestcare Pharmacy Grants LLC
- Bethphage
All providers in Grants, NM · Surgical Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.