LOS ALAMOS PEDIATRIC CLINIC (NPI# 1245248830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245248830 |
| Entity Type | Organization |
| Organization Name | LOS ALAMOS PEDIATRIC CLINIC |
| Practice Address |
3917 West Road Suite 136 Los Alamos NM 87544 |
| Practice Telephone | 5056629620 |
| Practice Fax Number | 5056620024 |
| Mailing Telephone | 5056629620 |
| Mailing Fax Number | 5056620024 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JACQUELINE ANNE KROHN (PRESIDENT) |
| Authorized Official Telephone | 5096629620 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 79195 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 11783 | 05 | |
| NM | LOVELACE HEALTH | 10003513 | 01 |
| NM | MOLINA HEALTHCARE | PROVP13573 | 01 |
| NM | HMA NAVAJO NATION | 6693 | 01 |
| NM | BCBS | NM011552 | 01 |
| Street Address |
3917 WEST ROAD SUITE 136 |
| City | LOS ALAMOS |
| State | NM |
| Zip Code | 87544 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780663369 | Fredrica E Smith | Internal Medicine | 3917 West Road, Suite D, Los Alamos, NM 87544 | 2006-01-12 |
| 1659798775 | Adriana Gonzales | Nurse Practitioner | 3917 West Road, Ste. A, Los Alamos, NM 87544 | 2014-03-26 |
| 1992003412 | Marvel E. Harrison | Counselor | 3917 West Road, Suite M250, Los Alamos, NM 87544 | 2011-03-08 |
| 1134450885 | Sangre De Cristo Heart Center | Internal Medicine | 3917 West Road, Suite 101, Los Alamos, NM 87544 | 2010-01-20 |
| 1194817155 | Miguel T Dozier | Internal Medicine | 3917 West Road, Ste 128, Los Alamos, NM 87544 | 2006-09-28 |
| 1376505958 | Lori Anne Fay | Family Medicine | 3917 West Road, Suite 150 Lamcc, Los Alamos, NM 87544 | 2006-04-06 |
| 1104888783 | John Matthew Fay | Family Medicine | 3917 West Road, Suite A Mannm, Los Alamos, NM 87544 | 2006-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679945935 | Zia Home Health | Home Health | 1475 Central Ave., Suite 125, Los Alamos, NM 87544 | 2015-10-27 |
| 1295131167 | Sara Pocernik | Dietitian, Registered | 1450 Iris Street, Los Alamos, NM 87544 | 2014-11-05 |
| 1760824890 | Lisa Renee Marr Lyon | Psychologist | 3917 West Road, Suite 128, Children's Clinic, P.a., Los Alamos, NM 87544 | 2013-07-17 |
| 1558629725 | Rachel Meyer | Dentist | 112 Central Park Square, Los Alamos, NM 87544 | 2012-04-25 |
| 1902183908 | Susana T. Chavarria | Occupational Therapist | 5 Quemazon Pl., Los Alamos, NM 87544 | 2011-11-04 |
| 1881998664 | Dr. Tom Child and Adolescent Medicine | Pediatrics | Los Alamos Medical Center, 3917 West Rd, Suite M250, Los Alamos, NM 87544 | 2011-01-07 |
| 1952565905 | Dawn Judy Barr | Social Worker | 3 Agila Ct, Los Alamos, NM 87544 | 2008-07-17 |
| 1649452129 | Ellen Vandergust Ballard | Dentist | 111 Longview, Suite B-3, White Rock, NM 87544 | 2007-11-27 |
| 1629290283 | Wildwind Dental | Dentist | 111 Longview Drive, Suite B3, Los Alamos, NM 87544 | 2007-05-03 |
| 1255407342 | Sarah Sue Teasdale | Counselor | 1362 C Trinity Dr, Los Alamos, NM 87544 | 2006-11-28 |
| Find all providers in zip 87544 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881998664 | Dr. Tom Child and Adolescent Medicine | Pediatrics | Los Alamos Medical Center, 3917 West Rd, Suite M250, Los Alamos, NM 87544 | 2011-01-07 |
| 1679793277 | Childrens Clinic, P.a. | Pediatrics | 3917 West Rd, Suite 128, Los Alamos, NM 87544-2275 | 2007-04-26 |
| 1336155936 | Claudia Sanchez | Pediatrics | 3917 West Rd, Suite 150, Los Alamos, NM 87544-2275 | 2006-08-01 |
| 1942290283 | Jacqueline Anne Krohn | Pediatrics | 3917 West Rd, Suite 136, Los Alamos, NM 87544-2275 | 2005-10-27 |
| 1790779007 | Shelley P Schoonover | Pediatrics | 3917 West Rd, Ste 128, Los Alamos, NM 87544-2275 | 2005-09-01 |
| 1922092139 | Mary Ellen Slaughter | Pediatrics | 3917 West Rd, Suite 128, Los Alamos, NM 87544-2275 | 2005-09-01 |
| 1821082033 | John Bennett Neal | Pediatrics | 3917 West Rd, #128, Los Alamos, NM 87544-2275 | 2005-09-01 |
| 1730173949 | Michael W Nichols | Pediatrics | 3917 West Rd, #128, Los Alamos, NM 87544-2275 | 2005-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538770698 | Dr Jedd Raney Pediatrics LLC | Pediatrics | 2402 W Pierce St Ste 3c, Carlsbad, NM 88220-3564 | 2020-08-12 |
| 1386296044 | Andrea Grano | Pediatrics | 1534 Unser Blvd Se, Rio Rancho, NM 87124-6377 | 2019-07-12 |
| 1851814784 | Ally Renee Funkhouser Dye | Pediatrics | 2130 Eubank Blvd Ne, Albuquerque, NM 87112 | 2017-07-23 |
| 1528417953 | Sofia Michelle Markee | Pediatrics | 1 University of New Mexico Pediatric Department, Albuquerque, NM 87131-0001 | 2016-06-07 |
| 1619363751 | Lauren N Gabreski | Pediatrics | Us Air Force, 377 Mdg/sghc, 2050a Second Street Se, Albuquerque, NM 87117-5522 | 2015-04-15 |
| 1174918197 | Ross Newman | Pediatrics | 2211 Lomas Blvd Ne # 3acc, Albuquerque, NM 87106-2719 | 2015-04-06 |
| 1366850216 | Anila Ejjigani | Pediatrics | 1245 Country Club Rd Ste 200, Santa Teresa, NM 88008-9743 | 2014-07-23 |
| 1942612650 | Amy M Rouse | Pediatrics | 933 Bradbury Dr Se Ste 222, Albuquerque, NM 87106 | 2014-05-29 |
| 1184048142 | Herbert Koffler | Pediatrics | 41 Agua Sarca Rd, Placitas, NM 87043-9405 | 2014-02-11 |
| 1104255454 | Victor Lacerva | Pediatrics | 52 Zambra Way, Santa Fe, NM 87506-0154 | 2013-11-07 |
| Find all providers with the same taxonomy | ||||
| City | LOS ALAMOS |
| Zip Code | 87544 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.