Dr. Phil Pediatrics, P. a.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

86-266 Issued in NM

Legal business name

DR. PHIL PEDIATRICS, P. A.

Practice address

4111 Barbara Loop SE Ste a
Rio Rancho, NM 87124-1068

Phone

(505) 994-3256

Fax

(866) 967-7905

NPI assigned

Oct 3, 2008

Last updated

May 6, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kalie Perkins

Title

Office Manager

Phone

(505) 994-3256

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557100800000",
    "number": "1972754356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 BARBARA LOOP SE STE A",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241068",
            "telephone_number": "505-994-3256",
            "fax_number": "866-967-7905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 BARBARA LOOP SE STE A",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241068",
            "telephone_number": "505-994-3256",
            "fax_number": "866-967-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. PHIL PEDIATRICS, P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2019-05-06",
        "status": "A",
        "authorized_official_last_name": "PERKINS",
        "authorized_official_first_name": "KALIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-994-3256"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NM",
            "license": "86-266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1437159993",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30197",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; 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.