Bhasker Medical Clinic PC
Organization Active NPI Family Medicine Physician · Socorro, NM
NPI 1821189101 · NPPES record last updated Sep 9, 2015
Key facts
- NPI
- 1821189101
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BHASKER MEDICAL CLINIC PC
- Practice address
- 200 Neel Ave
Socorro, NM 87801-4649 - Phone
- (575) 835-2940
- Fax
- (575) 835-2216
- NPI assigned
- Sep 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Addy Bhasker
- Title
- Administrator
- Phone
- (575) 835-2940
Practitioners 3
-
Ravi Bhasker, MD
-
Vincent Muller, PHYSICIAN ASSISTANT
-
Valerie Young, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D0536895 | Bhasker Medical Clinic | Certificate of waiver | Oct 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031114000164 | NM | Part B Supplier - Clinic/Group Practice | 0547174567 |
Receives reassigned benefits from 2 practitioners Practice locations: Socorro, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X |
Addresses
Primary practice location
200 Neel Ave
Socorro, NM 87801-4649
Mailing address
200 Neel Ave
Socorro, NM 87801-4649
Phone (575) 835-2940
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44073 | Medicaid | NM | |
| 201051377 | Other | NM | PREJB |
Other providers in Socorro, NM
- Jessie B Batchelor
- Duane H Beers
- Cirk Russell Bejnar
- Darla H Bejnar
- Lindsey Benjamin
- Ravi Bhasker
- Bird and Compass Therapy LLC
- William Brewster Bird
- Body Wise Therapy Services LLC
- Laurie Borden
All providers in Socorro, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.