Active NPI
Johannes Jacobus Heynekamp, MD
- Family Medicine Physician
- Socorro, NM
National Provider Identifier
1710103239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 79-179
- Practice address
- 200 Neel Ave
Socorro, NM 87801 - Phone
- (575) 835-2940
- Fax
- (575) 835-2216
- NPI assigned
- Apr 17, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 79-179 | NM | |
| Family Medicine Physician | 207Q00000X | 79-179 | NM | Primary |
Addresses
Primary practice location
200 Neel Ave
Socorro, NM 87801
Mailing address
200 Neel Ave
Socorro, NM 87801
Phone (575) 835-2940
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00063578 | Medicaid | NM |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79-179 | NM | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Mexico Heart Institute, LLC | Past | Accepting new patients | |
| Lea Emergency Group LLC | Emergency Medicine | Past | Accepting new patients |
| Roswell Hospital Corporation | Family Medicine | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Hobbs, NM
- NPI 1063521938
-
- Cardiovascular Disease Physician
- Albuquerque, NM
- NPI 1346242575
-
dba Eastern New Mexico Medical Center
- Family Medicine Physician
- Roswell, NM
- NPI 1427001759
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373328000000",
"number": "1710103239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 NEEL AVE",
"city": "SOCORRO",
"state": "NM",
"postal_code": "87801",
"telephone_number": "575-835-2940",
"fax_number": "575-835-2216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 NEEL AVE",
"city": "SOCORRO",
"state": "NM",
"postal_code": "87801",
"telephone_number": "575-835-2940",
"fax_number": "575-835-2216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEYNEKAMP",
"first_name": "JOHANNES",
"middle_name": "JACOBUS",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-17",
"last_updated": "2013-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NM",
"license": "79-179",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "79-179",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00063578",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Socorro, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.