Individual provider Active NPI

Mary L. Grebenc, M.D.

  • Diagnostic Radiology Physician
  • Albuquerque, NM
National Provider Identifier
1699727347
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
90-199 Issued in NM
Practice address
1 Unm
Albuquerque, NM 87131-3616
Phone
(505) 272-2525
Fax
(505) 272-6055
NPI assigned
May 17, 2006
Last updated
Mar 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X G87233 CA
Diagnostic Radiology Physician 2085R0202X 90-199 NM Primary

Addresses

Primary practice location

1 Unm
Albuquerque, NM 87131-3616

Mailing address

800 Bradbury Dr SE Ste 116
Albuquerque, NM 87106-4310
Phone (505) 272-1476

Other identifiers 2

IdentifierTypeStateIssuer
00G872330MedicaidCA
00G872330OtherCABLUE SHIELD PIN

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address UNMCCC@direct.health.unm.edu
Direct Messaging Address SRMC@direct.health.unm.edu
Direct Messaging Address UNMH@direct.health.unm.edu
Direct Messaging Address UNMMG@direct.health.unm.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NM2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041026000729 CA Practitioner - Diagnostic Radiology 6406817030 Reassigns benefits to 2 organizations
I20110630000635 NM Practitioner - Diagnostic Radiology 6406817030 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of New Mexico School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Unm Medical Group IncGroup PAC ID 4981795267, 1,052 clinicians

Practice addresses (Care Compare)

2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Phone (505) 272-2111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G87233CAMDDiagnostic Radiology Physician
90-199NMMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unm Medical Group, Inc. CurrentSince Jan 4, 2023 Accepting new patients
Golden State Imaging Associates Inc Diagnostic Radiology CurrentSince Apr 13, 2020 Accepting new patients
Unm Medical Group Inc CurrentSince Jan 4, 2023 Accepting new patients
Quality Medical Imaging of Arizona, Inc CurrentSince Feb 14, 2012 Accepting new patients

Locations

17100 Euclid St
Fountain Vly, CA 92708
Phone (714) 966-7200

17100 Euclid St
Ste 4004
Fountain Vly, CA 92708
Phone (714) 966-7200

47111 Monroe St
#1112
Indio, CA 92201

933 Bradbury Dr SE
Ste 2222
Albuquerque, NM 87106
Phone (505) 272-1476

1201 Camino de Salud NE
Albuquerque, NM 87102
Phone (505) 272-4443

800 Bradbury Dr SE
Ste 116
Albuquerque, NM 87106
Phone (505) 272-1476

3001 Broadmoor Blvd NE
Rio Rancho, NM 87144
Phone (505) 994-7000

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

Organizations & group practices 5

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 2

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1699727347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BRADBURY DR SE STE 116",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064310",
            "telephone_number": "505-272-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNM",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871313616",
            "telephone_number": "505-272-2525",
            "fax_number": "505-272-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREBENC",
        "first_name": "MARY",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G87233",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NM",
            "license": "90-199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G872330",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN",
            "identifier": "00G872330",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMCCC@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "1201 Camino De Salud NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871024517",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SRMC@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "3001 Broadmoor Blvd NE",
            "city": "Rio Rancho",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871442100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMH@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "2211 Lomas Blvd NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871062719",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMMG@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "800 Bradbury Dr SE Ste 116",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871064310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.