| Sunrise Medical Group, Pc | |
|
552 Highway 54 Santa Rosa NM 88435-2215 | |
| (505) 433-5572 | |
| (877) 651-1259 |
| Full Name | Sunrise Medical Group, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 552 Highway 54, Santa Rosa, New Mexico |
| Authorized Official Name and Position | Jessica Sanchez (CREDENTIALING) |
| Authorized Official Contact | 5754724311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunrise Medical Group, Pc 552 Highway 54 Santa Rosa NM 88435-2215 Ph: (505) 433-5572 | Sunrise Medical Group, Pc 552 Highway 54 Santa Rosa NM 88435-2215 Ph: (505) 433-5572 |
| NPI Number | 1124107446 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 10/11/2023 |
| Medicare PECOS PAC ID | 6406744028 |
|---|---|
| Medicare Enrollment ID | O20040305000978 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124107446 | NPI | - | NPPES |
| 600521016 | Other | MEDICARE GROUP ID | |
| 00074686 | Medicaid | NM | |
| 1124107446 | Other | NM | GROUP NPI |
| 6794 | Other | NM | NM HEALTH DEPT. NO. |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 6794 (New Mexico) | Primary |
| Provider Name | Randal W Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376636159 PECOS PAC ID: 5991693525 Enrollment ID: I20060116000168 |
| Provider Name | Connie J Trujillo |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1023217650 PECOS PAC ID: 6406943901 Enrollment ID: I20071031000198 |
| Provider Name | Sheryl A Gambardella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255518817 PECOS PAC ID: 7911063813 Enrollment ID: I20090302000114 |
| Provider Name | Antje Postl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639255300 PECOS PAC ID: 4587799473 Enrollment ID: I20100317000570 |
| Provider Name | David Neil Calkins |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1407966369 PECOS PAC ID: 2163310061 Enrollment ID: I20110914000580 |
| Provider Name | Aileen C Swope |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306132899 PECOS PAC ID: 2264692748 Enrollment ID: I20120320000590 |
| Provider Name | Haily Wallace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679839534 PECOS PAC ID: 7719299338 Enrollment ID: I20150709002052 |
| Provider Name | Mary M Kenyon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366824963 PECOS PAC ID: 6406154913 Enrollment ID: I20160418001026 |
| Provider Name | Chelsea A Gutierrez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891117552 PECOS PAC ID: 7618267469 Enrollment ID: I20160607000461 |
| Provider Name | Laura Mardo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720432271 PECOS PAC ID: 2365733318 Enrollment ID: I20160622000129 |
| Provider Name | James Gonzales |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730507955 PECOS PAC ID: 3476850116 Enrollment ID: I20170405002161 |
| Provider Name | Jesus A Tafoya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992118145 PECOS PAC ID: 5395034946 Enrollment ID: I20170819000139 |
| Provider Name | Mark L Grossetete |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447592498 PECOS PAC ID: 3577798909 Enrollment ID: I20180906001151 |
| Provider Name | Sally A Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861981193 PECOS PAC ID: 5193076172 Enrollment ID: I20181002001068 |
| Provider Name | Janoi Gonzalez Camejo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902364730 PECOS PAC ID: 8820323207 Enrollment ID: I20190708000836 |
| Provider Name | Pamela M Ammons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679138671 PECOS PAC ID: 9739414020 Enrollment ID: I20190709001393 |
| Provider Name | Senora L Campos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225695018 PECOS PAC ID: 4385979269 Enrollment ID: I20190715002430 |
| Provider Name | Michael Dunkle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306389846 PECOS PAC ID: 5991080079 Enrollment ID: I20190722001471 |
| Provider Name | Steven T Lackey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649222910 PECOS PAC ID: 6800817776 Enrollment ID: I20190829000440 |
| Provider Name | Amber Nolen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548815897 PECOS PAC ID: 6103258116 Enrollment ID: I20191113001203 |
| Provider Name | Denia Guinart Gutierrez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568946861 PECOS PAC ID: 6002240504 Enrollment ID: I20191216001633 |
| Provider Name | Shaylee A Abeyta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316510886 PECOS PAC ID: 6901290170 Enrollment ID: I20220303002846 |
Sunrise Clinics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 658 S 5th St, Santa Rosa, NM 88435 Phone: 575-472-7747 Fax: 877-651-0289 | |
Santa Rosa Lion Care Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 717 S 3rd St, Santa Rosa, NM 88435 Phone: 505-426-2262 Fax: 505-454-1473 | |
Sunrise Clinics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 116 Camino De Vida, Santa Rosa, NM 88435 Phone: 575-472-7747 Fax: 877-651-0289 | |
Santa Rosa Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 533 Lake Dr, Santa Rosa, NM 88435 Phone: 505-472-4311 Fax: 505-472-4313 |