Jodi A. Dettman, CNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

CNP01152 Issued in NM

Practice address

104 Quail TRL Unit B
Edgewood, NM 87015-7185

Phone

(505) 208-0204

NPI assigned

Nov 14, 2007

Last updated

May 4, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ambercare Home Health Home health agency, Belen, NM, CCN 327123
• Lovelace Women's Hospital Hospital, Albuquerque, NM, CCN 320017

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Zia Primary Care, LLC

  • Family Medicine Physician
  • Edgewood, NM
  • NPI 1831802230

  Adult Health

  Medicare reassignment NPD

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

• Ambercare Home Health Care Corporation

  dba Ambercare Home Health

  • Home Health Agency
  • Belen, NM
  • NPI 1336117621
  Care Compare affiliation
• Lovelace Health System, LLC

  dba Lovelace Women's Hospital

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1982799375
  Care Compare affiliation

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525392000000",
    "number": "1720269178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 QUAIL TRL UNIT B",
            "city": "EDGEWOOD",
            "state": "NM",
            "postal_code": "870157185",
            "telephone_number": "505-208-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 QUAIL TRL UNIT B",
            "city": "EDGEWOOD",
            "state": "NM",
            "postal_code": "870157185",
            "telephone_number": "505-208-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTMAN",
        "first_name": "JODI",
        "middle_name": "A.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2018-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NM",
            "license": "CNP01152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sonya Cooper, L.M.T #5343
• Mary Ann Crow, FNP-C
• Kelly S Dickson, LCSW
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• Sterling Donner
• Cierra Dorado
• East Mountain Eye Clinic PC

• Adult Health Nurse Practitioner in Edgewood, NM
• Providers in Edgewood, NM by specialty
• Adult Health Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.