DERMATOLOGY OF NEW MEXICO LLC
NPI 1104468438
Clinic/Center in Albuquerque, NM
NPI Status: Active since October 08, 2019
Contact Information
610 BROADWAY BLVD NE
ALBUQUERQUE, NM
ZIP 87102
Phone: (505) 225-2500
Fax: (505) 225-2025
- Organization
- Clinic/Center
- CLIA Number: 32D2177486
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 01-04-2027
About DERMATOLOGY OF NEW MEXICO LLC
This page provides the complete NPI Profile along with additional information for Dermatology Of New Mexico Llc, a provider established in Albuquerque, New Mexico operating as a Clinic/center. The healthcare provider is registered in the NPI registry with number 1104468438 assigned on October 2019. The practitioner's primary taxonomy code is 261Q00000X. The provider is registered as an organization and their NPI record was last updated July 2025. The authorized official of this NPI record is Suraj2252500 Reddy Md (Ceo / Md)
- NPI
- 1104468438
- Provider Name
- DERMATOLOGY OF NEW MEXICO LLC
- Entity Type
- Organization
- Location Address
- 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102
- Location Phone
- (505) 225-2500
- Location Fax
- (505) 225-2025
- Mailing Address
- 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102
- Mailing Phone
- (505) 225-2500
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-08-2019
- Last Update Date
- 07-30-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center
- Taxonomy Code
- 261Q00000X
- Type
- Ambulatory Health Care Facilities
- Taxonomy Description
- A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 32D2177486
- Facility Type
- Physician Office
- Certificate Effective Date
- January 05, 2025
- Certificate Expiration Date
- January 04, 2027
- Laboratory Director
- SURAJ G. REDDY
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Dermatology Of New Mexico Llc after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 0 | 4 | 4 | 6 | 8 | 4 | 3 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 0 | 4 | 8 | 6 | 16 | 4 | 6 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 0 + 4 + 8 + 6 + 1 + 6 + 4 + 6 + 24 = 62 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 62 = 8 | 8 | ||||||||
The NPI number 1104468438 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 14 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1184659997 | DR. VAUN TAYLOR FLOYD JR. M.D. Individual | Urology | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1376569921 | ALBUQUERQUE UROLOGY ASSOCIATES, PA Organization | Urology | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1508034588 | JAMIE F EDENS PA-C Individual | Physician Assistant (Medical) | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1366865560 | DEITRA GATES CNS Individual | Clinical Nurse Specialist (Adult Health) | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1932514056 | LINDA KAREN LEE NP-C Individual | Nurse Practitioner (Family) | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1386691772 | DR. STEFAN H. GUTOW M.D. Individual | Specialist | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1821424219 | ANNA E KNACKSTEDT P.A. Individual | Physician Assistant (Medical) | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1497844203 | MRS. SABRINA M JOHNSON PA-C Individual | Physician Assistant | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 225-2500 |
| 1639218639 | DR. SHILPA GOPAL REDDY MD Individual | Dermatology | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 225-2500 |
| 1740485275 | DR. SURAJ GOPAL REDDY M.D. Individual | Dermatology | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 225-2500 |
| 1134394430 | DR. PETER ABRAHAM HEADLEY M.D. Individual | Urology | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1811157100 | ANDREW GROLLMAN M.D. Individual | Urology | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1639174550 | DR. AARON J GESWALDO DO Individual | Urology | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
| 1477983849 | SHELLY ANN MINISH PA-C Individual | Physician Assistant (Medical) | 610 BROADWAY BLVD NE ALBUQUERQUE, NM 87102 (505) 242-3991 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104468438, enumerated in the NPI registry as an "organization" on October 08, 2019
The provider is located at 610 Broadway Blvd Ne Albuquerque, Nm 87102 and the phone number is (505) 225-2500
This medical organization specializes in Clinic/Center with taxonomy code 261Q00000X
The provider's CLIA number is 32D2177486 for a "physician office" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing..
This NPI record was last updated on October 08, 2019. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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