Bianca Antonia McDermott, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

745 Issued in NM

Practice address

10 Tesuque St
Kewa, NM 87052-9998

Phone

(505) 221-4061

Fax

(505) 465-0433

NPI assigned

Jun 23, 2016

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Southwest Medical Associates, LLC

  • General Practice Physician
  • Albuquerque, NM
  • NPI 1164491072

  NM

  Medicare reassignment NPD
• Southwest Medical Associates, LLC

  • Rural Health Clinic/Center
  • Roswell, NM
  • NPI 1578255253
  NPD

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1811348667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DUENDE ROAD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87508",
            "telephone_number": "505-221-4061",
            "fax_number": "505-465-0433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 TESUQUE ST",
            "city": "KEWA",
            "state": "NM",
            "postal_code": "870529998",
            "telephone_number": "505-221-4061",
            "fax_number": "505-465-0433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDERMOTT",
        "first_name": "BIANCA",
        "middle_name": "ANTONIA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NM",
            "license": "745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leon Aragon, LCSW
• Christopher Lovato
• Iris Reano, CHW
• Joseph Sabaquie, LSAA

• All providers in Kewa, NM
• Clinical Psychologist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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.