Zia Primary Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ZIA PRIMARY CARE, LLC

Practice address

104 Quail TRL Ste B
Edgewood, NM 87015-7197

Phone

(505) 926-9800

NPI assigned

Dec 30, 2022

Last updated

Jan 28, 2023By 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

Ashley Autrey

Title

Credentialing

Phone

(505) 249-1369

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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.

• Lindsay Sue Cerrone, FNP-C

  • Nurse Practitioner
  • Edgewood, NM
  • NPI 1861028102

  Family Medicine

  Medicare reassignment NPD
• Jodi A. Dettman, CNP

  • Adult Health Nurse Practitioner
  • Edgewood, NM
  • NPI 1720269178
  Medicare reassignment NPD

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

{
    "created_epoch": "1672358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674864000000",
    "number": "1831802230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 QUAIL TRL STE B",
            "city": "EDGEWOOD",
            "state": "NM",
            "postal_code": "870157197",
            "telephone_number": "505-926-9800",
            "fax_number": "505-926-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 QUAIL TRL STE B",
            "city": "EDGEWOOD",
            "state": "NM",
            "postal_code": "870157197",
            "telephone_number": "505-926-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ZIA PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-30",
        "last_updated": "2023-01-28",
        "certification_date": "2023-01-28",
        "status": "A",
        "authorized_official_last_name": "AUTREY",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "505-249-1369"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Wiseman
• David McAllister Withey
• Melissa A Wolf, LPCC
• Sanford Lee Yankow, MD
• Zachcurriedds LLC

• Family Medicine Physician in Edgewood, NM
• Providers in Edgewood, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2023; 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.