NPIMap

Organization Active NPI

Psychogenesis LLC

Doing business as Psychogenesis

  • Psychiatry Physician
  • Albuquerque, NM
National Provider Identifier
1922646595
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
PSYCHOGENESIS LLC
Doing business as
Psychogenesis
Practice address
3900 Eubank Blvd NE Ste 18
Albuquerque, NM 87111-3427
Phone
(505) 585-3744
NPI assigned
Dec 14, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Authorized official

Name
Javier Vera, MDNPI 1093789265
Title
Owner
Phone
(505) 585-3744

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

3900 Eubank Blvd NE Ste 18
Albuquerque, NM 87111-3427

Mailing address

PO Box 93274
Albuquerque, NM 87199-3274

Other names 1

  • Psychogenesis Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1576281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1922646595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 93274",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871993274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 EUBANK BLVD NE STE 18",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113427",
            "telephone_number": "505-585-3744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOGENESIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-14",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "VERA",
        "authorized_official_first_name": "JAVIER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-585-3744",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychogenesis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 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.