NM Spirit of Wellness LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NM SPIRIT OF WELLNESS LLC

Practice address

123 Girard Blvd SE
Albuquerque, NM 87106-2227

Phone

(505) 264-9454

Fax

(505) 557-1941

NPI assigned

Mar 18, 2019

Organization subpart

No

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

Authorized official

Name

Jeannett Martinez, NPNPI 1629543640

Title

Ceo

Phone

(505) 264-9454

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NM Spirit of wellness LC Doing business as

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19099/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeannett Martinez

  • Family Nurse Practitioner
  • Albuquerque, NM
  • NPI 1629543640
  NPD Authorized official

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

{
    "created_epoch": "1552867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571529600000",
    "number": "1982163267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 GIRARD BLVD SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871062227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 GIRARD BLVD SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871062227",
            "telephone_number": "505-264-9454",
            "fax_number": "505-557-1941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NM SPIRIT OF WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-18",
        "last_updated": "2019-10-20",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "JEANNETT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-264-9454",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14350673",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NM Spirit of wellness LC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NM Spirit of wellness LC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Albuquerque, NM
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.