Individual provider Active NPI

Pretty Sara Idiculla, MD

  • Internal Medicine Physician
  • Las Cruces, NM
National Provider Identifier
1811647522
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD2025-0863 Issued in NM
Practice address
4311 E Lohman Ave Ste 300
Las Cruces, NM 88011-8255
Phone
(575) 556-7600
NPI assigned
Mar 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD2025-0863 NM Primary

Addresses

Primary practice location

4311 E Lohman Ave Ste 300
Las Cruces, NM 88011-8255

Mailing address

4351 E Lohman Ave Ste 300
Las Cruces, NM 88011-8262

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250829001108 NM Practitioner - Internal Medicine 5799286837 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Las Cruces HB Medical Services LLCGroup PAC ID 8123473600, 157 clinicians
Las Cruces Physician Services LLCGroup PAC ID 8224122759, 104 clinicians

Practice addresses (Care Compare)

4311 E Lohman Ave
Las Cruces, NM 88011-8255
Phone (575) 556-7455

4371 E Lohman Ave
Las Cruces, NM 88011-8255
Phone (575) 522-7798

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2025-0863NMMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Las Cruces HB Medical Services LLC CurrentSince Aug 15, 2025 Accepting new patients
Las Cruces Physician Services LLC CurrentSince Oct 19, 2025 Accepting new patients
Las Cruces Medical Center LLC Past Accepting new patients
Familycare Associates,PA Past Accepting new patients

Locations

4371 E Lohman Ave
Las Cruces, NM 88011
Phone (575) 323-3938

4311 E Lohman Ave
Ste 300
Las Cruces, NM 88011
Phone (575) 556-7600

1135 S Main St
Ste B
Las Cruces, NM 88005
Phone (505) 522-5205

4311 E Lohman Ave
Las Cruces, NM 88011
Phone (505) 556-6800

Interoperability endpoints

  • Direct secure messaging: pretty.idiculla.1@1928.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1811647522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4351 E LOHMAN AVE STE 300",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 E LOHMAN AVE STE 300",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118255",
            "telephone_number": "575-556-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDICULLA",
        "first_name": "PRETTY",
        "middle_name": "SARA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-25",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "MD2025-0863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.