NPIMap

Individual provider Active NPI

Shavonne Truong

  • Family Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1699342493
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
69751 Issued in NM
Practice address
4420 Irving Blvd NW
Albuquerque, NM 87114-5915
Phone
(505) 727-6300
NPI assigned
Jun 9, 2021
Last updated
Feb 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 69751 NM Primary

Addresses

Primary practice location

4420 Irving Blvd NW
Albuquerque, NM 87114-5915

Mailing address

4420 Irving Blvd NW
Albuquerque, NM 87114-5915
Phone (505) 727-6300

Other practice location 1

3825 Eubank Blvd NE Ste A
Albuquerque, NM 87111-3590
Phone (505) 292-8575

Other identifiers 1

IdentifierTypeStateIssuer
1083802029OtherNMFAMILY MEDICINE, PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230223000603 NM Practitioner - Nurse Practitioner 2769855642 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southwest Medical Associates, LLCGroup PAC ID 7214831114, 326 clinicians

Practice addresses (Care Compare)

4420 Irving Blvd NW
Albuquerque, NM 87114-5915
Phone (505) 727-6300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, LLC Family Medicine CurrentSince Apr 1, 2024 Accepting new patients
Southwest Medical Associates, LLC Family Medicine CurrentSince Apr 1, 2024 Accepting new patients
Spencer J Hardenbrook MD PC Family Medicine CurrentSince May 11, 2023 Accepting new patients
Family Medicine PC Family Medicine CurrentSince Jan 9, 2023 Accepting new patients

Locations

715 Martin Luther King Ave NE
Ste 301
Albuquerque, NM 87102
Phone (505) 727-4500

4420 Irving Blvd NW
Albuquerque, NM 87114
Phone (505) 727-6300

3825 Eubank Blvd NE
Ste A
Albuquerque, NM 87111
Phone (505) 292-8575

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1699342493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 IRVING BLVD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145915",
            "telephone_number": "505-727-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 IRVING BLVD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145915",
            "telephone_number": "505-727-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3825 Eubank Blvd NE Ste A",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871113590",
            "country_code": "US",
            "telephone_number": "505-292-8575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRUONG",
        "first_name": "SHAVONNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2024-02-27",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "69751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY MEDICINE, PC",
            "identifier": "1083802029",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.