Michael Dudelczyk, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

7524 Issued in NM

Practice address

1807 2ND St Ste 44B
Santa Fe, NM 87505-3519

Phone

(505) 757-7080

Fax

(505) 757-7080

NPI assigned

Apr 27, 2006

Last updated

Nov 12, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

New York Medical College, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Life LinkGroup PAC ID 7012078199, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• The Life Link

  • Community/Behavioral Health Agency
  • Santa Fe, NM
  • NPI 1841332400
  Medicare reassignment Care Compare group
• Haskell Indian Health Center

  • Federal Public Health Clinic/Center
  • Lawrence, KS
  • NPI 1700915782
  NPD (past)

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321056000000",
    "number": "1942267596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 2ND ST STE 44B",
            "address_2": "SUITE 44B",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875053519",
            "telephone_number": "505-757-7080",
            "fax_number": "505-757-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 2ND ST STE 44B",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875053519",
            "telephone_number": "505-757-7080",
            "fax_number": "505-757-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDELCZYK",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2011-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "7524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2303",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Naja Druva, LMHC
• Elisa Joy Dry, MA, OTR/L
• Kimberly Duarte Ramirez
• Tamara Dubinsky, LPCC
• Fiquet Hanna Duckworth, DOM
• Abraham Duffy
• Sarah Louise Dufort
• Martha A. Duganne, PT
• James Duke
• Gerald Dukeminier, D.O.M.,

• Psychiatry Physician in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Psychiatry Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.