NPIMap

Organization Active NPI

Stephanie Gonzalez DPM PA

  • Podiatric Clinic/Center
  • Las Cruces, NM
National Provider Identifier
1972127512
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Podiatric Clinic/CenterTaxonomy code 261QP1100X
Legal business name
STEPHANIE GONZALEZ DPM PA
Doing business as
Stephanie Gonzalez, DPM, PA
Practice address
4151 Camino Coyote Ste B
Las Cruces, NM 88011-7096
Phone
(575) 680-2227
Fax
(575) 680-2228
NPI assigned
May 29, 2020
Organization subpart
Yes
Parent organization
STEPHANIE GONZALEZ DPM PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Authorized official

Name
Stephanie Gonzalez, DPMNPI 1396146957
Title
Podiatrist/Owner
Phone
(575) 680-2227

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
Podiatric Clinic/Center 261QP1100X Primary

Addresses

Primary practice location

4151 Camino Coyote Ste B
Las Cruces, NM 88011-7096

Mailing address

PO Box 221463
El Paso, TX 79913-4463
Phone (575) 680-2227

Other names 1

  • Stephanie Gonzalez, DPM, PA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200710000290 NM Part B Supplier - Clinic/Group Practice 9739501545 Receives reassigned benefits from 1 practitioner
Practice locations: Las Cruces, NM

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Stephanie Gonzalez DPM PA

Locations

4151 Camino Coyote
Ste B
Las Cruces, NM 88011
Phone (575) 680-2227

3003 Hillrise Dr
Ste A
Las Cruces, NM 88011
Phone (505) 521-7550

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": "1590710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1972127512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221463",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799134463",
            "telephone_number": "575-680-2227",
            "fax_number": "575-680-2228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 CAMINO COYOTE STE B",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880117096",
            "telephone_number": "575-680-2227",
            "fax_number": "575-680-2228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANIE GONZALEZ DPM PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEPHANIE GONZALEZ DPM PA",
        "enumeration_date": "2020-05-29",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "PODIATRIST/OWNER",
        "authorized_official_telephone_number": "575-680-2227",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stephanie Gonzalez, DPM, PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stephanie Gonzalez, DPM, PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.