Ilse Aimee Carrillo, LMSW
Individual provider Active NPI Social Worker · Anthony, NM
NPI 1659949410 · NPPES record last updated Feb 9, 2022
Key facts
- NPI
- 1659949410
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- X-12088 (NM)
- Practice address
- 826 Anthony Dr
Anthony, NM 88021-9317 - Phone
- (575) 201-5135
- Fax
- (575) 449-4052
- NPI assigned
- Jun 16, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Buen Salud Inc
Practice addresses (Care Compare)
101 Livingston Loop
Suite 1
Santa Teresa, NM 88008-9753
Phone (575) 824-9000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260129000255 | NM | Practitioner - Clinical Social Worker | 1052899390 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X-12088 | NM | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Buen Salud Inc | Current |
Accepting new patients |
Locations
101 Livingston Loop
Ste 1
Santa Teresa, NM 88008
Phone (575) 824-9000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | NM | ||
| Social Worker | 104100000X | X-12088 | NM | Yes |
Addresses
Primary practice location
826 Anthony Dr
Anthony, NM 88021-9317
Mailing address
385 Calle de Alegra Ste a
Las Cruces, NM 88005-3423
Phone (575) 526-1105
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46039767 | Medicaid | NM |
Other providers in Anthony, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2022. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.