MATTHEW BRUNS BERILLA (NPI# 1457865677) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457865677 |
| Entity Type | Individual |
| Full Name | MATTHEW BRUNS BERILLA |
| Practice Address |
1600 N Main Ave Lovington NM 88260 |
| Mailing Address |
1600 N Main Ave Lovington NM 88260-2830 |
| Practice Telephone | 5753966611 |
| Mailing Telephone | 5753966611 |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2019-10-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363A00000X | Physician Assistant | 1101867 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 091933402 | 05 | |
| NM | PA2019-0078 | PA2019-0078 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1600 N Main Ave, Lovington, NM 88260 | 5753966611 | |
| 2323 Texas St, Pecos, TX 797727338 | 4324473551 | 4324451566 |
| Street Address |
1600 N MAIN AVE |
| City | LOVINGTON |
| State | NM |
| Zip Code | 88260 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114924008 | Shannon Michelle Allen | Nurse Anesthetist, Certified Registered | 1600 N Main Ave, Lovington, NM 88260 | 2005-07-07 |
| 1811503303 | Megan Deanne Chavarria | Nurse Practitioner | 1600 N Main Ave, Lovington, NM 88260-2871 | 2020-09-20 |
| 1518587948 | Mary Victoria Cansino | Speech-Language Pathologist | 1600 N Main Ave, Lovington, NM 88260-2813 | 2020-04-27 |
| 1902449820 | Francisco Alonzo Espino | Nurse Practitioner | 1600 N Main Ave, Lovington, NM 88260-2830 | 2019-10-23 |
| 1306303326 | Zarah Mae Cortez | Physical Therapist | 1600 N Main Ave, Lovington, NM 88260-2830 | 2019-02-26 |
| 1285136119 | Lugene M Twiggs | Social Worker | 1600 N Main Ave, Lovington, NM 88260-2830 | 2018-03-07 |
| 1437650934 | Sandra Lizet Orozco | Physician Assistant | 1600 N Main Ave, Lovington, NM 88260-2830 | 2018-02-21 |
| 1841714300 | Brandi Lynnette Tedder | Nurse Practitioner | 1600 N Main Ave, Lovington, NM 88260-2830 | 2017-07-26 |
| 1255882718 | Jacqueline Marinovich | Nurse Practitioner | 1600 N Main Ave, Lovington, NM 88260-2830 | 2016-10-20 |
| 1558721589 | Nina Colvin | Dietitian, Registered | 1600 N Main Ave, Lovington, NM 88260-2830 | 2016-03-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548761034 | Debra Mauldin | Registered Nurse | 18 West Washington, Lovington, NM 88260 | 2018-02-21 |
| 1790283786 | Brenda D'ann Perry | Registered Nurse | 700 W Jefferson, Lovington, NM 88260 | 2018-01-25 |
| 1114433513 | Rebecca Madrid | Registered Nurse | 11 Ano 1000 S Main St, Lovington, NM 88260 | 2017-12-20 |
| 1588177414 | Kimberly Kay Reeder | Registered Nurse | 1400 S. 6th St, Lovington, NM 88260 | 2017-11-14 |
| 1508379439 | Jessica Fitzgerald | Registered Nurse | 1202 W Birch Ave, Lovington, NM 88260 | 2017-11-14 |
| 1245760362 | Dyesebel Morales Solis | Physical Therapist | 1600 N. Main Street, Nor-lea Hospital District, Lovington, NM 88260 | 2017-06-13 |
| 1962949172 | Especializados En Servicios Medicos Quirurgicos Sa De Cv | General Acute Care Hospital | A. Obregon 3256 Col. Jardin, Nuevo Laredo, TAMAULIPAS 88260 | 2017-01-25 |
| 1205386992 | Graciela Urbina | Dentist | O Campo 3147, Nvo Laredo, TAMPS 88260 | 2016-10-06 |
| 1710294913 | Lindsey Anitra Broom | Speech-Language Pathologist | 1300 W. Dogwood, Lovington, NM 88260 | 2010-09-09 |
| 1003129545 | Rosalinda Barraza | Occupational Therapist | 18 W Washington, Lovington, NM 88260 | 2010-07-26 |
| Find all providers in zip 88260 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437650934 | Sandra Lizet Orozco | Physician Assistant | 1600 N Main Ave, Lovington, NM 88260-2830 | 2018-02-21 |
| 1326494808 | Sharyn Bush | Physician Assistant | 1600 North Main, Lovington, NM 88260-2830 | 2016-05-13 |
| 1134522063 | Nneka Asiamigbe | Physician Assistant | 1600 N Main Ave, Lovington, NM 88260-2830 | 2014-10-07 |
| 1427451541 | Elise Amy Cho Rice | Physician Assistant | 1600 N Main Ave, Lovington, NM 88260 | 2014-10-02 |
| 1134436652 | Teresa Necole Reid | Physician Assistant | 1600 North Main, Lovington, NM 88260-2830 | 2010-09-03 |
| 1598098899 | Tessa Marie Torres | Physician Assistant | 1600 N Main Ave, Lovington, NM 88260-2830 | 2009-09-17 |
| 1720294457 | Peter Earl Carmany | Physician Assistant | 1600 N Main Ave, Lovington, NM 88260-2830 | 2007-05-16 |
| 1235341546 | Betty Rose Masden | Physician Assistant | 1600 N Main Ave, Lovington, NM 88260-2830 | 2007-05-07 |
| 1366411415 | Ricardo Wynter | Physician Assistant | 1600 North Main, Lovington, NM 88260-2830 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902405442 | Lauren Elise Pincomb Apodaca | Physician Assistant | 2415 Janet Ann Ln, Las Cruces, NM 88007-5119 | 2020-10-24 |
| 1609474550 | Mara Swartzentruber | Physician Assistant | 3310 Linda Vista Ave Se, Albuquerque, NM 87106-1514 | 2020-10-13 |
| 1336757301 | Dailey Doss | Physician Assistant | Raymond G. Murphy Va Medical Center, 1501 San Pedro Se, Albuquerque, NM 87108 | 2020-07-16 |
| 1487287413 | Thomas Clise | Physician Assistant | 629 San Pablo St Ne, Albuquerque, NM 87108-2137 | 2020-02-18 |
| 1306478870 | Holly Howe | Physician Assistant | 2300 Grande Blvd Se # 4045, Rio Rancho, NM 87124-1755 | 2020-02-12 |
| 1427680750 | Mckenzi Hoffman | Physician Assistant | 465 Saint Michaels Dr Bldg Suite107, Santa Fe, NM 87505-7670 | 2020-02-05 |
| 1225678543 | Charla Marie Dunn | Physician Assistant | 701 Arizona St Ste A, Clovis, NM 88101-2110 | 2020-01-14 |
| 1912547324 | Kathleen Joyce L'heureux | Physician Assistant | 8124 Ventana Cielo Ave Nw, Albuquerque, NM 87114-5988 | 2020-01-14 |
| 1033752357 | Daniel Ray Spohn | Physician Assistant | 1630 Rio Rancho Dr Se, Rio Rancho, NM 87124-1587 | 2019-10-18 |
| 1528615101 | Michael La | Physician Assistant | 1202 Main St Ne Ste A, Los Lunas, NM 87031-7421 | 2019-08-20 |
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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.