Active NPI
Doug Pendergrass, D.C.
- Chiropractor
- Flora Vista, NM
National Provider Identifier
1902942352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1679
- Practice address
- 12 Road 3540
Flora Vista, NM 87415-9601 - Phone
- (505) 860-0862
- Fax
- (505) 860-0862
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1679 | NM | Primary |
Addresses
Primary practice location
12 Road 3540
Flora Vista, NM 87415-9601
Mailing address
12 Road 3540
Flora Vista, NM 87415-9601
Phone (505) 860-0862
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8X8022 | Other | TX | BCBS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1679 | NM | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Horizon Chiropractic and Wellness Center PC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Chiropractor
- Arlington, TX
- NPI 1154543395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1451433600000",
"number": "1902942352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 ROAD 3540",
"city": "FLORA VISTA",
"state": "NM",
"postal_code": "874159601",
"telephone_number": "505-860-0862",
"fax_number": "505-860-0862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 ROAD 3540",
"city": "FLORA VISTA",
"state": "NM",
"postal_code": "874159601",
"telephone_number": "505-860-0862",
"fax_number": "505-860-0862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENDERGRASS",
"first_name": "DOUG",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2015-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NM",
"license": "1679",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8X8022",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flora Vista, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.