NPIMap

Organization Active NPI

Mesa Family Practice PC

  • Family Medicine Physician
  • Farmington, NM
National Provider Identifier
1881714632
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
95222 Issued in NM
Legal business name
MESA FAMILY PRACTICE PC
Practice address
2130A Farmington Ave
Farmington, NM 87401
Phone
(505) 325-2323
Fax
(505) 325-7172
NPI assigned
Mar 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Matthew Dekay, MDNPI 1053388058
Title
Owner Ceo
Phone
(505) 325-2323

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 95222 NM Primary

Addresses

Primary practice location

2130A Farmington Ave
Farmington, NM 87401

Mailing address

2130A Farmington Ave
Farmington, NM 87401
Phone (505) 325-2323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040520001004 NM Part B Supplier - Clinic/Group Practice 1153312970 Receives reassigned benefits from 6 practitioners
Practice locations: Farmington, NM

National Provider Directory

National Provider Directory

Locations

304 N Locke Ave
Farmington, NM 87401
Phone (505) 324-1100

2700 Farmington Ave
Bldg F
Farmington, NM 87401
Phone (505) 325-2323

2130 Farmington Ave
Ste A
Farmington, NM 87401
Phone (505) 325-2323

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881714632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130A FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-325-2323",
            "fax_number": "505-325-7172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130A FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-325-2323",
            "fax_number": "505-325-7172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEKAY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "505-325-2323",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "95222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.