Active NPI
Roger Benavidez
- Case Manager/Care Coordinator
- Las Vegas, NM
National Provider Identifier
1972246643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 3695 Hot Springs Blvd
Las Vegas, NM 87701-9549 - Phone
- (505) 454-2100
- Fax
- (505) 454-0397
- NPI assigned
- Apr 19, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
3695 Hot Springs Blvd
Las Vegas, NM 87701-9549
Mailing address
3695 Hot Springs Blvd
Las Vegas, NM 87701-9549
Phone (505) 454-2100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 96296 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650326400000",
"number": "1972246643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3695 HOT SPRINGS BLVD",
"city": "LAS VEGAS",
"state": "NM",
"postal_code": "877019549",
"telephone_number": "505-454-2100",
"fax_number": "505-454-0397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3695 HOT SPRINGS BLVD",
"city": "LAS VEGAS",
"state": "NM",
"postal_code": "877019549",
"telephone_number": "505-454-2100",
"fax_number": "505-454-0397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENAVIDEZ",
"first_name": "ROGER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-19",
"last_updated": "2022-04-19",
"certification_date": "2022-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "96296",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.