Michael Hennelly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

75-167 Issued in NM

Practice address

110 Sheep Springs
Jemez Pueblo, NM 87024-0279

Phone

(575) 834-7413

Fax

(575) 834-7517

NPI assigned

Mar 24, 2006

Sex

Male

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 TX

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

Specialty

Family Practice

Education

University of Missouri, Columbia School of Medicine, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pueblo of JemezGroup PAC ID 3971584509, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Pueblo of Jemez

  • Clinic/Center
  • Jemez Pueblo, NM
  • NPI 1417082215

  TX

  Medicare reassignment Care Compare group NPD
• Pueblo of Jemez

  • Clinic/Center
  • Jemez Pueblo, NM
  • NPI 1225346547
  NPD

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1871553933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "JEMEZ PUEBLO",
            "state": "NM",
            "postal_code": "870240279",
            "telephone_number": "575-834-7413",
            "fax_number": "575-834-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SHEEP SPRINGS",
            "city": "JEMEZ PUEBLO",
            "state": "NM",
            "postal_code": "870240279",
            "telephone_number": "575-834-7413",
            "fax_number": "575-834-7517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNELLY",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "75-167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alysha Aileen Gallegos-Yepa
• Paul Raymond Gooris, PA-C
• Robert A Gracey, OD
• Megan Patricia Greteman, PA-C
• Nancy Maybeth Harvey, RN, BSN, MPH
• Shari Jean Hiatt, PA
• Rachel Houseman, LPAT ATRBC LPCC
• Jemez Valley Community Wellness
• Jemez Valley Public Schools
• Roylynda Johnson, RDH

• Family Medicine Physician in Jemez Pueblo, NM
• Providers in Jemez Pueblo, 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 Sep 25, 2024; 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.
• 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.