Albuquerque Dermatology Associates, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2000-166 Issued in NM

Legal business name

ALBUQUERQUE DERMATOLOGY ASSOCIATES, PA

Practice address

4610 Jefferson LN NE
Albuquerque, NM 87109-2117

Phone

(505) 872-4700

Fax

(505) 872-4709

NPI assigned

May 28, 2006

Last updated

Mar 6, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Estelle B Miller

Title

Practice Manager

Phone

(505) 872-4700

Specialties & licenses 9

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 16

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.

• Sky B Connolly, MD

  • MOHS-Micrographic Surgery Physician
  • Albuquerque, NM
  • NPI 1194710442

  Dermatology

  Medicare reassignment Care Compare group NPD
• Rebecca A Smith-Sealy, FNP

  • Family Nurse Practitioner
  • Albuquerque, NM
  • NPI 1346614591
  Medicare reassignment Care Compare group NPD
• Brian L. Costello, PA-C

  • Medical Physician Assistant
  • Albuquerque, NM
  • NPI 1154306454
  Medicare reassignment Care Compare group
• Monique A. Herrera, CNP

  • Family Nurse Practitioner
  • Albuquerque, NM
  • NPI 1750886404
  Medicare reassignment NPD
• Suraj Gopal Reddy, M.D.

  • Dermatology Physician
  • Albuquerque, NM
  • NPI 1740485275
  Medicare reassignment NPD
• Karen Dwyer, PA

  • Medical Physician Assistant
  • Albuquerque, NM
  • NPI 1336191964
  NPD (past)
• Barbara Einhorn, M.D.

  • Specialist
  • Albuquerque, NM
  • NPI 1376576462
  NPD (past)
• Dawit Kidane, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Albuquerque, NM
  • NPI 1619562675
  NPD (past)
• Luis Alfonso Padilla-Paz, M.D.

  • Gynecologic Oncology Physician
  • Albuquerque, NM
  • NPI 1336252063
  NPD (past)
• Marissa A Pettit, CNP

  • Acute Care Nurse Practitioner
  • Albuquerque, NM
  • NPI 1831528090
  NPD (past)
• Carrie D Swartz, M.D.

  • Gynecology Physician
  • Albuquerque, NM
  • NPI 1386653822
  NPD (past)
• Leo B Twiggs, M.D.

  • Gynecologic Oncology Physician
  • Albuquerque, NM
  • NPI 1639193337
  NPD (past)

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1821045329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 JEFFERSON LN NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871092117",
            "telephone_number": "505-872-4700",
            "fax_number": "505-872-4709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 JEFFERSON LN NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871092117",
            "telephone_number": "505-872-4700",
            "fax_number": "505-872-4709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBUQUERQUE DERMATOLOGY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ESTELLE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "505-872-4700",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NM",
            "license": "2002-0450",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NM",
            "license": "R46867NM",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NM",
            "license": "MD2005-0405",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NM",
            "license": "2000-166",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NM",
            "license": "2000-166",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NM",
            "license": "2000-166",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NM",
            "license": "2002-0450",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NM",
            "license": "R46867NM",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NM",
            "license": "MD2005-0405",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76659755",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93885865",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47235306",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44792",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F1418",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Dermatology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.