Active NPI
Beverly A Pucka, MD
- Gynecology Physician
- Albuquerque, NM
National Provider Identifier
1881701191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 86107
- Practice address
- 1001 Coal Ave SE
Albuquerque, NM 87106-5205 - Phone
- (505) 843-6168
- Fax
- (505) 792-1978
- NPI assigned
- Aug 23, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 86107 | NM | Primary |
Addresses
Primary practice location
1001 Coal Ave SE
Albuquerque, NM 87106-5205
Mailing address
6320 Riverside Plaza LN NW Ste B
Albuquerque, NM 87120-1710
Phone (505) 843-6168
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37325 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86107 | NM | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527033600000",
"number": "1881701191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6320 RIVERSIDE PLAZA LN NW STE B",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871201710",
"telephone_number": "505-843-6168",
"fax_number": "505-792-1978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 COAL AVE SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871065205",
"telephone_number": "505-843-6168",
"fax_number": "505-792-1978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKA",
"first_name": "BEVERLY",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-23",
"last_updated": "2018-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "NM",
"license": "86107",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "37325",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.