Organization Active NPI

St. Vincent Hospital

  • Diabetes Educator Registered Nurse
  • Santa Fe, NM
National Provider Identifier
1659540201
Registry record updated Feb 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
Legal business name
ST. VINCENT HOSPITAL
Practice address
465 Saint Michaels Dr
Suite 115
Santa Fe, NM 87505-7670
Phone
(505) 946-4307
Fax
(505) 946-4308
NPI assigned
Feb 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2010

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

Authorized official

Name
J Alex Valdez
Title
President & Ceo
Phone
(505) 820-5202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diabetes Educator Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WD0400X Primary

Addresses

Primary practice location

465 Saint Michaels Dr
Suite 115
Santa Fe, NM 87505-7670

Mailing address

455 Saint Michaels Dr
Medical Staff Office
Santa Fe, NM 87505-7601
Phone (505) 946-4307

Other identifiers 1

IdentifierTypeStateIssuer
8916200MedicaidNM

Other names 1

  • Diabetes Center of Excellence Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000372 NM Part B Supplier - Clinic/Group Practice 6608775135 Receives reassigned benefits from 425 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Santa Fe, NM; Los Alamos, NM; Albuquerque, NM; Espanola, NM; Farmington, NM; Las Vegas, NM

National Provider Directory

National Provider Directory

Locations

4 Calle Medico
Santa Fe, NM 87505

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1659540201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 SAINT MICHAELS DR",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057601",
            "telephone_number": "505-946-4307",
            "fax_number": "505-946-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 SAINT MICHAELS DR",
            "address_2": "SUITE 115",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057670",
            "telephone_number": "505-946-4307",
            "fax_number": "505-946-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "VALDEZ",
        "authorized_official_first_name": "J",
        "authorized_official_middle_name": "ALEX",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "505-820-5202"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8916200",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes Center of Excellence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Fe, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.