Organization Active NPI

Dr Osvelia G Deeds LLC

  • Psychologist
  • Albuquerque, NM
National Provider Identifier
1912275124
Registry record updated Dec 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1095 Issued in NM
Legal business name
DR OSVELIA G DEEDS LLC
Practice address
5203 Juan Tabo Blvd NE Ste 2B
Albuquerque, NM 87111-2691
Phone
(505) 850-5314
Fax
(505) 221-5710
NPI assigned
Dec 2, 2011
Last updated
Dec 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2011

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

Authorized official

Name
Dawn Halfacre
Title
Credentialing Specialist
Phone
(505) 352-5269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1095 NM Primary

Addresses

Primary practice location

5203 Juan Tabo Blvd NE Ste 2B
Albuquerque, NM 87111-2691

Mailing address

1542 Rosalba St NE
Albuquerque, NM 87112-6552
Phone (505) 850-5314

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, AZ, NV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20120119000111 NM Part B Supplier - Clinic/Group Practice 5799952578 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM
O20160201000059 AZ Part B Supplier - Clinic/Group Practice 5799952578 Receives reassigned benefits from 1 practitioner
Practice locations: Bullhead City, AZ
O20250227001362 NV Part B Supplier - Clinic/Group Practice 5799952578 Receives reassigned benefits from 1 practitioner
Practice locations: Boulder City, NV

National Provider Directory

National Provider Directory

Locations

930 N Switzer Canyon Dr
Ste 102A
Flagstaff, AZ 86001

930 N Switzer Canyon Dr
Ste 105
Flagstaff, AZ 86001

9301 Indian School Rd NE
Ste 115B
Albuquerque, NM 87112

9301 Indian School Rd NE
Ste 200A
Albuquerque, NM 87112
Phone (214) 518-2035

916 Nevada Way
Ste 77
Boulder City, NV 89005

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322784000000",
    "number": "1912275124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 ROSALBA ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871126552",
            "telephone_number": "505-850-5314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5203 JUAN TABO BLVD NE STE 2B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112691",
            "telephone_number": "505-850-5314",
            "fax_number": "505-221-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR OSVELIA G DEEDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-02",
        "last_updated": "2011-12-02",
        "status": "A",
        "authorized_official_last_name": "HALFACRE",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "505-352-5269"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NM",
            "license": "1095",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Dec 2, 2011; 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.