NPIMap

Organization Active NPI

Fedko Emergency Physicians New Mexico LLC

  • Emergency Medicine Physician
  • Grants, NM
National Provider Identifier
1770047441
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
FEDKO EMERGENCY PHYSICIANS NEW MEXICO LLC
Practice address
1016 E Roosevelt Ave
Grants, NM 87020-2118
Phone
(505) 287-4446
NPI assigned
Jan 28, 2019
Last updated
Jan 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Authorized official

Name
Martin FedkoNPI 1134351430
Title
Owner
Phone
(857) 571-2467

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1016 E Roosevelt Ave
Grants, NM 87020-2118

Mailing address

7725 W Reno Ave
Oklahoma City, OK 73127-9711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190320001146 NM Part B Supplier - Clinic/Group Practice 4880934389 Receives reassigned benefits from 132 practitioners
Practice locations: Clovis, NM; Deming, NM; Grants, NM; Portales, NM

National Provider Directory

National Provider Directory

Locations

7725 W Reno Ave
Oklahoma City, OK 73127
Phone (405) 206-1313

Practitioners & affiliated clinicians

Practitioners 132

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 132

NPI Registry JSON

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

{
    "created_epoch": "1548633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1770047441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7725 W RENO AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731279711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 E ROOSEVELT AVE",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870202118",
            "telephone_number": "505-287-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FEDKO EMERGENCY PHYSICIANS NEW MEXICO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-28",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "FEDKO",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "857-571-2467"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.