Active NPI
Tana Chavez
- Peer Specialist
- San Felipe Pueblo, NM
National Provider Identifier
1760065817
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 1115
- Practice address
- P.O Box 4339
San Felipe Pueblo, NM 87001 - Phone
- (505) 771-1463
- Fax
- (505) 771-9994
- NPI assigned
- May 5, 2021
- Last updated
- Apr 9, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CSA0223991 | NM | |
| Peer Specialist | 175T00000X | 1115 | NM | Primary |
Addresses
Primary practice location
P.O Box 4339
San Felipe Pueblo, NM 87001
Mailing address
9201 Montgomery Blvd NE Ste 5
Albuquerque, NM 87111-2468
Phone (505) 217-1717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21720827 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CSA0223991 | NM | MD | Addiction (Substance Use Disorder) Counselor |
| 1115 | NM | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712620800000",
"number": "1760065817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9201 MONTGOMERY BLVD NE STE 5",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871112468",
"telephone_number": "505-217-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "P.O BOX 4339",
"city": "SAN FELIPE PUEBLO",
"state": "NM",
"postal_code": "87001",
"telephone_number": "505-771-1463",
"fax_number": "505-771-9994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVEZ",
"first_name": "TANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-05",
"last_updated": "2024-04-09",
"certification_date": "2024-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "CSA0223991",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NM",
"license": "1115",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "21720827",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Felipe Pueblo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.