Individual provider Active NPI

Michael Christian Ponce, D.C.

  • Chiropractor
  • El Paso, TX
National Provider Identifier
1790074409
Registry record updated Sep 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
11693 Issued in TX
Practice address
3215 Gateway Blvd W
El Paso, TX 79903-4225
Phone
(915) 598-7246
Fax
(915) 633-6598
NPI assigned
Apr 4, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 11693 TX Primary

Addresses

Primary practice location

3215 Gateway Blvd W
El Paso, TX 79903-4225

Mailing address

3215 Gateway Blvd W
El Paso, TX 79903-4225
Phone (915) 598-7246

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110525000378 TX Practitioner - Chiropractic 6204012347 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5001 N Mesa St
El Paso, TX 79912-5932
Phone (915) 449-6453

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11693TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Epmed, PA Current Accepting new patients
Aktiv Integrative Chiropractic, PLLC CurrentSince Jul 15, 2016 Accepting new patients

Locations

3215 Gateway Blvd W
El Paso, TX 79903
Phone (915) 598-7246

7825 N Mesa St
El Paso, TX 79932
Phone (915) 598-7246

12200 Paseo Nuevo Dr
El Paso, TX 79928
Phone (915) 342-3399

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378857600000",
    "number": "1790074409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 GATEWAY BLVD W",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799034225",
            "telephone_number": "915-598-7246",
            "fax_number": "915-633-6598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 GATEWAY BLVD W",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799034225",
            "telephone_number": "915-598-7246",
            "fax_number": "915-633-6598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE",
        "first_name": "MICHAEL",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-04",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "11693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.