Active NPI
Douglas Terry Gillis, DPM
- Podiatrist
- Las Cruces, NM
National Provider Identifier
1689667792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 196
- Practice address
- 780 S Walnut St
Suite 3
Las Cruces, NM 88001-1425 - Phone
- (505) 525-3980
- Fax
- (505) 526-8529
- NPI assigned
- Aug 24, 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 |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 196 | NM | Primary |
Addresses
Primary practice location
780 S Walnut St
Suite 3
Las Cruces, NM 88001-1425
Mailing address
780 S Walnut St
Suite 3
Las Cruces, NM 88001-1425
Phone (505) 525-3980
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0469220001 | Other | NM | DMERC |
| 88001A00Z | Other | NM | TRICARE WPS |
| 52993 | Medicaid | NM | |
| 16042 | Other | NM | PRESBYTERIAN |
| NM005364 | Other | NM | BC BS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 194 | NM | MD | Registered Dietitian |
| 196 | NM | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193616000000",
"number": "1689667792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "780 S WALNUT ST",
"address_2": "SUITE 3",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880011425",
"telephone_number": "505-525-3980",
"fax_number": "505-526-8529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "780 S WALNUT ST",
"address_2": "SUITE 3",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880011425",
"telephone_number": "505-525-3980",
"fax_number": "505-526-8529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIS",
"first_name": "DOUGLAS",
"middle_name": "TERRY",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-24",
"last_updated": "2007-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "NM",
"license": "196",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC",
"identifier": "0469220001",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE WPS",
"identifier": "88001A00Z",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52993",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESBYTERIAN",
"identifier": "16042",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "NM005364",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.