Cody W Lewis, PA-C
Individual provider Active NPI Medical Physician Assistant · Farmington, NM
NPI 1972859403 · NPPES record last updated Jan 18, 2021
Key facts
- NPI
- 1972859403
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA2012-0021 (NM)
- Practice address
- 2300 E 30TH St BLDG D Ste 101
Farmington, NM 87401 - Phone
- (505) 327-1400
- Fax
- (505) 564-3202
- NPI assigned
- Aug 2, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NM, TX, CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120816000859 | NM | Practitioner - Physician Assistant | 4789830191 | Reassigns benefits to 3 organizations |
| I20181105000428 | TX | Practitioner - Physician Assistant | 4789830191 | Reassigns benefits to 1 organization |
| I20240715004172 | CO | Practitioner - Physician Assistant | 4789830191 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presbyterian Medical Services | Current |
Accepting new patients | |
| Presbyterian Medical Services | Current |
Accepting new patients | |
| DHHS, PHS, Naihs, Shiprock Hospital | Current |
Accepting new patients | |
| DHHS, PHS, Naihs, Shiprock Hospital | Current |
Accepting new patients | |
| San Juan Oncology Associates, PC | Current |
Accepting new patients | |
| Orthopedic Associates PA | Current |
Accepting new patients |
Locations
1305 Escalante Dr
Ste 102103
Durango, CO 81303
Phone (505) 564-6850
6 Road 7586
Bloomfield, NM 87413
Phone (505) 368-8015
2300 E 30th St
Bldg D-101
Farmington, NM 87401
Phone (505) 327-1400
1422 Paseo de Peralta
Santa Fe, NM 87501
Phone (505) 982-5565
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA60796883 | WA | |
| Medical Physician Assistant | 363AM0700X | PA2012-0021 | NM | Yes |
Addresses
Primary practice location
2300 E 30TH St BLDG D Ste 101
Farmington, NM 87401
Mailing address
2300 E 30TH St BLDG D Ste 101
Farmington, NM 87401
Phone (505) 327-1400
Other practice location 1
5600 Eubank Blvd NE Ste 110
Albuquerque, NM 87111
Phone (505) 880-1920
Other practice location 2
1001 W Broadway
Farmington, NM 87401
Phone (505) 327-4796
Other practice location 3
1001 W Broadway
Farmington, NM 87401
Phone (505) 327-4796
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 58372539 | Medicaid | NM |
Other providers in Farmington, NM
- Savannah Lesser
- Christopher Lesueur
- Stephanie A Lew
- Brianna Lewis
- Christy Lewis
- Gerald A. Lewis
- Justin Lewis
- Krista Lewis
- Ronald Alan Tung Li
- Life Quality Chiropractic, LLC
All providers in Farmington, NM · Medical Physician Assistant in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.