Active NPI
Jerry N King, M.D.
- Vascular & Interventional Radiology Physician
- Albuquerque, NM
National Provider Identifier
1669476396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular & Interventional Radiology Physician
- License
- 80-52
- Practice address
- 4411 The 25 Way NE
Ste 150
Albuquerque, NM 87109-5888 - Phone
- (505) 332-6900
- Fax
- (505) 332-6921
- NPI assigned
- Jun 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | 80-52 | NM | Primary |
Addresses
Primary practice location
4411 The 25 Way NE
Ste 150
Albuquerque, NM 87109-5888
Mailing address
4411 The 25 Way NE
Ste 150
Albuquerque, NM 87109-5888
Phone (505) 332-6900
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45138 | Medicaid | NM | |
| 52713 | Medicaid | NM | |
| 700521102 | Other | NM | MEDICARE GROUP |
| L0634 | Medicaid | NM | |
| 2258272 | Other | NM | MEDICARE GROUP |
| 600521002 | Other | NM | MEDICARE IDTF |
| 800521126 | Other | NM | MEDICARE IDTF |
| 9035 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Imaging LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Body Imaging Physician
- Albuquerque, NM
- NPI 1851363972
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394582400000",
"number": "1669476396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4411 THE 25 WAY NE",
"address_2": "STE 150",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871095888",
"telephone_number": "505-332-6900",
"fax_number": "505-332-6921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 THE 25 WAY NE",
"address_2": "STE 150",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871095888",
"telephone_number": "505-332-6900",
"fax_number": "505-332-6921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "JERRY",
"middle_name": "N",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-10",
"last_updated": "2014-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "NM",
"license": "80-52",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "45138",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52713",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "700521102",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "L0634",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP",
"identifier": "2258272",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE IDTF",
"identifier": "600521002",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE IDTF",
"identifier": "800521126",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9035",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.