Individual provider Active NPI

Joseph W Morris, PA-C

  • Physician Assistant
  • Acoma, NM
National Provider Identifier
1912905498
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102245 Issued in NC
Practice address
80 B Veterans Blvd
I-40, Exit 102
Acoma, NM 87034
Phone
(505) 552-5300
Fax
(505) 552-5828
NPI assigned
Jul 8, 2005
Last updated
Mar 19, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 102245 NC Primary

Addresses

Primary practice location

80 B Veterans Blvd
I-40, Exit 102
Acoma, NM 87034

Mailing address

PO Box 130
Attn Acl Provider Enrollment
San Fidel, NM 87049-0130
Phone (505) 552-5300

Other identifiers 1

IdentifierTypeStateIssuer
H3451MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140408001524 TX Practitioner - Physician Assistant 3173533916 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
003863NYMDNeurological Surgery Physician
102245NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Physicians of Gaston County, PLLC Past Accepting new patients
Carolina Family Medicine & Urgent Care PA Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1912905498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "address_2": "ATTN ACL PROVIDER ENROLLMENT",
            "city": "SAN FIDEL",
            "state": "NM",
            "postal_code": "870490130",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 B VETERANS BLVD",
            "address_2": "I-40, EXIT 102",
            "city": "ACOMA",
            "state": "NM",
            "postal_code": "87034",
            "telephone_number": "505-552-5300",
            "fax_number": "505-552-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORRIS",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H3451",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Acoma, NM

Sources for this page

Verify at the official NPI Registry.