Active NPI
Shadi Kamal Jawad
- Behavior Technician
- Albuquerque, NM
National Provider Identifier
1912477449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1855 Sigma CHI Rd NE
Albuquerque, NM 87106-3816 - NPI assigned
- Nov 27, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | NM | Primary |
Addresses
Primary practice location
1855 Sigma CHI Rd NE
Albuquerque, NM 87106-3816
Mailing address
1508 Fairways Cir
Gallup, NM 87301-4937
Phone (505) 879-0043
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10204943900 | Other | NM | CENTENNIAL CARE |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543276800000",
"number": "1912477449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1508 FAIRWAYS CIR",
"city": "GALLUP",
"state": "NM",
"postal_code": "873014937",
"telephone_number": "505-879-0043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1855 SIGMA CHI RD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871063816"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAWAD",
"first_name": "SHADI",
"middle_name": "KAMAL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-27",
"last_updated": "2018-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NM",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CENTENNIAL CARE",
"identifier": "10204943900",
"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 Nov 27, 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.