Individual provider Active NPI

Ann Marie Vaughn, MD

  • Family Medicine Physician
  • Shiprock, NM
National Provider Identifier
1992792170
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00037475 Issued in WA
Practice address
US Hwy 491 North
Shiprock, NM 87420
Phone
(505) 368-6001
Fax
(505) 368-7011
NPI assigned
Oct 3, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00037475 WA Primary

Addresses

Primary practice location

US Hwy 491 North
Shiprock, NM 87420

Mailing address

PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6001

Other identifiers 3

IdentifierTypeStateIssuer
53850327MedicaidCO
G8307MedicaidNM
620816MedicaidAZ

Other names 1

  • Ann Marie Weberg Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Vaughn.AM@SRSU.directihs.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080731000144 TX Practitioner - Family Practice 6002980646 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00037475WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Feb 5, 2013 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Feb 5, 2013 Accepting new patients

Locations

6 Road 7586
Bloomfield, NM 87413
Phone (505) 368-8015

Interoperability endpoints

  • Direct secure messaging: vaughn.am@srsu.directihs.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1992792170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "874200160",
            "telephone_number": "505-368-6001",
            "fax_number": "505-368-7011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "US HWY 491 NORTH",
            "city": "SHIPROCK",
            "state": "NM",
            "postal_code": "87420",
            "telephone_number": "505-368-6001",
            "fax_number": "505-368-7011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-03",
        "last_updated": "2021-08-10",
        "certification_date": "2021-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00037475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53850327",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G8307",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620816",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Vaughn.AM@SRSU.directihs.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "US Hwy 491 North",
            "city": "Shiprock",
            "state": "NM",
            "country_code": "US",
            "postal_code": "87420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANN",
            "last_name": "WEBERG",
            "middle_name": "MARIE",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Shiprock, NM

Sources for this page

Verify at the official NPI Registry.