Individual provider Active NPI

Manuel Vaquera, MD

  • Family Medicine Physician
  • El Paso, TX
National Provider Identifier
1700069010
Registry record updated Aug 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD2010-0255 Issued in NM
Practice address
5001 N Piedras St
El Paso, TX 79930-4210
Phone
(915) 564-6100
Fax
(575) 522-1497
NPI assigned
Dec 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2015

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 MD2010-0255 NM Primary

Addresses

Primary practice location

5001 N Piedras St
El Paso, TX 79930-4210

Mailing address

5001 N Piedras St
El Paso, TX 79930-4210
Phone (915) 564-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170915000895 TX Order and Referring Only - Family PracticePractitioner - Family Practice 5799718029

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD2010-0255NMMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
El Paso Community Home Health, Inc. PastSince Apr 30, 2003 Accepting new patients
Las Cruces Physician Services LLC PastSince May 1, 2007 Accepting new patients
Familycare Associates,PA Family Medicine Past Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
El Paso Community Home Health, Inc.El Paso, TX, CCN 679519 Home health agency 5% Or Greater Direct Ownership Interest (33.3%)
Corporate Officer (33.3%)
May 17, 2005
Jan 5, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1700069010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 N PIEDRAS ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799304210",
            "telephone_number": "915-564-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 N PIEDRAS ST",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799304210",
            "telephone_number": "915-564-6100",
            "fax_number": "575-522-1497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAQUERA",
        "first_name": "MANUEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-10",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "MD2010-0255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.