Mariana Mejia Botero, M.D.
Individual provider Active NPI Family Medicine Physician · Paraje, NM
NPI 1679893374 · NPPES record last updated Apr 19, 2021
Key facts
- NPI
- 1679893374
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD2016-0719 (NM)
- Practice address
- 6 Basswood Rd
Paraje, NM 87007-1004 - Phone
- (505) 431-0711
- NPI assigned
- Jun 3, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of New Mexico School of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Laguna Healthcare Corporation
Practice addresses (Care Compare)
6 Basswood Rd
Paraje, NM 87007-1004
Phone (505) 552-5664
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151022000116 | TX | Practitioner - Family Practice | 7012168354 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Laguna Healthcare Corporation | Current |
Accepting new patients | |
| Pueblo Pintado Clinic | Current |
Accepting new patients | |
| Thoreau Clinic | Current |
Accepting new patients | |
| Laguna Healthcare Corporation | Family Medicine | Current |
Accepting new patients |
| DHHS PHS Naihs Crownpoint Hospital | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD2016-0719 | NM | Yes |
Addresses
Primary practice location
6 Basswood Rd
Paraje, NM 87007-1004
Mailing address
PO Box 549
Paraje, NM 87007-0549
Phone (505) 431-0711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H3451 | Medicaid | NM | |
| 78721016 | Medicaid | NM |
Other providers in Paraje, NM
- Kimberly Chapman-Natewa
- Claudia Erin Hannah
- Laguna Healthcare Corporation
- Laguna Healthcare Corporation
- Laguna Healthcare Corporation
- Nicolas Milligan
- Lori Ann Ortiz
- Pueblo of Laguna
- Marian Ramsey-Ford
All providers in Paraje, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 19, 2021. 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.