Organization Active NPI

John R. Vigil, MD, LLC

  • General Practice Physician
  • Albuquerque, NM
National Provider Identifier
1992084008
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
89-319 Issued in NM
Legal business name
JOHN R. VIGIL, MD, LLC
Practice address
3900 Eubank Blvd NE Ste 18
Albuquerque, NM 87111-3427
Phone
(505) 884-3344
NPI assigned
Aug 6, 2011
Last updated
Oct 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Johnnie R VigilNPI 1285762377
Title
Owner/MD
Phone
(505) 263-1422

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
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 89-319 NM Primary

Addresses

Primary practice location

3900 Eubank Blvd NE Ste 18
Albuquerque, NM 87111-3427

Mailing address

205 W Boutz Rd BLDG 1
Las Cruces, NM 88005-3259
Phone (575) 532-7000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130729000607 NM Part B Supplier - Clinic/Group Practice 9830330174 Receives reassigned benefits from 6 practitioners
Practice locations: Albuquerque, NM; Las Cruces, NM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2139041John R Vigil3900 Eubank Blvd NE Ste 12, Albuquerque, NM 87111Certificate of waiverOct 29, 2027

National Provider Directory

National Provider Directory

Locations

10753 Prospect Ave NE
Ste B
Albuquerque, NM 87112
Phone (505) 299-6878

3150 Carlisle Blvd NE
Ste 106
Albuquerque, NM 87110
Phone (505) 633-8173

3900 Eubank Blvd NE
Albuquerque, NM 87111
Phone (505) 298-5522

3900 Eubank Blvd NE
Ste 12
Albuquerque, NM 87111
Phone (505) 294-6009

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1312588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1992084008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 W BOUTZ RD BLDG 1",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053259",
            "telephone_number": "575-532-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 EUBANK BLVD NE STE 18",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113427",
            "telephone_number": "505-884-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN R. VIGIL, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-06",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "VIGIL",
        "authorized_official_first_name": "JOHNNIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "505-263-1422"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "NM",
            "license": "89-319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.