Brenda F Bongetta, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2019-0064 Issued in NM

Practice address

3331 Del Rey Blvd
Las Cruces, NM 88012-7713

Phone

(575) 373-1033

NPI assigned

Aug 11, 2019

Last updated

Sep 20, 2022By 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et1256.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Truth Or Consequences, NM
  • NPI 1871528505
  Medicare reassignment
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Hatch, NM
  • NPI 1154352532
  NPD
• Ben Archer Health Center

  dba Ben Archer Health Center Deming School Base

  • Federally Qualified Health Center (FQHC)
  • Deming, NM
  • NPI 1194443135
  NPD
• Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Alamogordo, NM
  • NPI 1902831977
  NPD (past)

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

{
    "created_epoch": "1565481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1760038368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "HATCH",
            "state": "NM",
            "postal_code": "879370370",
            "telephone_number": "575-267-3270",
            "fax_number": "575-267-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 DEL REY BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880127713",
            "telephone_number": "575-373-1033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3452 Valverde Loop",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880128553",
            "country_code": "US",
            "telephone_number": "575-571-9813",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3452 Valverde Loop",
            "address_purpose": "LOCATION",
            "city": "Las Cruces",
            "state": "NM",
            "postal_code": "880128553",
            "country_code": "US",
            "telephone_number": "575-571-9813",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1960 N Date St",
            "address_purpose": "LOCATION",
            "city": "T OR C",
            "state": "NM",
            "postal_code": "87901",
            "country_code": "US",
            "telephone_number": "575-894-7662",
            "fax_number": "575-894-7930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONGETTA",
        "first_name": "BRENDA",
        "middle_name": "F",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-11",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2019-0064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.