NPIMap

Organization Active NPI

Santa Rosa Medical Clinic

  • Internal Medicine Physician
  • Santa Rosa, NM
National Provider Identifier
1922039171
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20020002 Issued in NM
Legal business name
SANTA ROSA MEDICAL CLINIC
Practice address
533 Lake Dr
Santa Rosa, NM 88435
Phone
(505) 472-4311
Fax
(505) 472-4313
NPI assigned
Jul 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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. Sergio Edgardo Abriola, MD
Title
Medical Doctor
Phone
(505) 472-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20020002 NM Primary

Addresses

Primary practice location

533 Lake Dr
Santa Rosa, NM 88435

Mailing address

533 Lake Dr
Santa Rosa, NM 88435
Phone (505) 472-4311

Other identifiers 1

IdentifierTypeStateIssuer
78150728MedicaidNM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922039171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "533 LAKE DR",
            "city": "SANTA ROSA",
            "state": "NM",
            "postal_code": "88435",
            "telephone_number": "505-472-4311",
            "fax_number": "505-472-4313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "533 LAKE DR",
            "city": "SANTA ROSA",
            "state": "NM",
            "postal_code": "88435",
            "telephone_number": "505-472-4311",
            "fax_number": "505-472-4313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ABRIOLA",
        "authorized_official_first_name": "SERGIO",
        "authorized_official_middle_name": "EDGARDO",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "505-472-4311",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "20020002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78150728",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.