NPIMap

Organization Active NPI

Roswell Clinic Corp

  • Family Medicine Physician
  • Roswell, NM
National Provider Identifier
1649267618
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROSWELL CLINIC CORP
Practice address
350 W Country Club Rd
Ste 201
Roswell, NM 88201-5205
Phone
(888) 801-5554
NPI assigned
Oct 4, 2005
Last updated
Jan 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ROSWELL CLINIC CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Senior Director, Enrollment
Phone
(877) 892-9815

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NM Primary
Internal Medicine Physician 207R00000X
Cardiovascular Disease Physician 207RC0000X
Pulmonary Disease Physician 207RP1001X
Obstetrics & Gynecology Physician 207V00000X
Orthopaedic Surgery Physician 207X00000X
Surgery Physician 208600000X
Sleep Medicine (Internal Medicine) Physician 207RS0012X

Addresses

Primary practice location

350 W Country Club Rd
Ste 201
Roswell, NM 88201-5205

Mailing address

4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7000

Other identifiers 4

IdentifierTypeStateIssuer
NPI AND TINOtherNMBCBS
60806516MedicaidNM
DD5451OtherNMRR MEDICARE
DA5509OtherNMRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000799 NM Part B Supplier - Clinic/Group Practice 9436062759 Receives reassigned benefits from 69 practitioners
4 other NPIs on this enrollment
Practice locations: Roswell, NM; Hobbs, NM; Carlsbad, NM; Artesia, NM

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Roswell Clinic Corp

Locations

509 W Mahone Dr
Ste B
Artesia, NM 88210
Phone (505) 748-0203

300 W Country Club Rd
Ste 130
Roswell, NM 88201
Phone (575) 625-2669

350 W Country Club Rd
Ste 101
Roswell, NM 88201
Phone (575) 622-1841

350 W Country Club Rd
Ste 105
Roswell, NM 88201
Phone (575) 624-4651

350 W Country Club Rd
Ste 2
Roswell, NM 88201

350 W Country Club Rd
Ste 201
Roswell, NM 88201
Phone (575) 622-1841

350 W Country Club Rd
Ste 203
Roswell, NM 88201
Phone (575) 624-4646

Practitioners & affiliated clinicians

Practitioners 191

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.

View all 191

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643068800000",
    "number": "1649267618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-7000",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W COUNTRY CLUB RD",
            "address_2": "STE 201",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015205",
            "telephone_number": "888-801-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSWELL CLINIC CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROSWELL CLINIC CORP",
        "enumeration_date": "2005-10-04",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR DIRECTOR, ENROLLMENT",
        "authorized_official_telephone_number": "877-892-9815"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "NPI AND TIN",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60806516",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DD5451",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DA5509",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.