NPIMap

Organization Active NPI

Summit Emergency Medicine LLC

  • Emergency Medicine Physician
  • Las Vegas, NM
National Provider Identifier
1679112130
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SUMMIT EMERGENCY MEDICINE LLC
Practice address
104 Legion Dr
Las Vegas, NM 87701-4804
Phone
(505) 426-3930
NPI assigned
Jan 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Authorized official

Name
Caleb O'Rear
Title
Authorized Official
Phone
(505) 426-3930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

104 Legion Dr
Las Vegas, NM 87701-4804

Mailing address

104 Legion Dr
Las Vegas, NM 87701-4804

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200219001436 NM Part B Supplier - Clinic/Group Practice 9032546783 Receives reassigned benefits from 24 practitioners
Practice locations: Las Vegas, NM

National Provider Directory

National Provider Directory

Practitioners 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1577923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1679112130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LEGION DR",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LEGION DR",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014804",
            "telephone_number": "505-426-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT EMERGENCY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-02",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "O'REAR",
        "authorized_official_first_name": "CALEB",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "505-426-3930"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; 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.