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RUBEN A. SUPAN, LLC
NPI 1053802892
Nurse Practitioner - Family in Roswell, NM

Active since May 29, 2018
405 W COUNTRY CLUB RD, ROSWELL, NM 88201(575) 363-3134(575) 208-0780 Get Directions Write a Review

NPPES record last updated: July 6, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 6, 2021, Dec 18, 2018, Sep 27, 2018 and 2 more (5 updates tracked since 2018).

About Ruben A. Supan, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RUBEN A. SUPAN, LLC (NPI 1053802892) is a healthcare organization registered as a family in Roswell, New Mexico and active in the NPI registry since May 2018. The organization lists Ruben Supan, Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1053802892
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameRUBEN A. SUPAN, LLC
Location Address405 W COUNTRY CLUB RDRoswell, NM 88201-5209
Mailing AddressPo Box 8244Roswell, NM 88202-8244 · (575) 208-0224
Phone(575) 363-3134
Fax(575) 208-0780
Organization SubpartNo
Authorized OfficialRuben SupanNurse Practitioner · (505) 409-0831
Enumeration DateMay 29, 2018
Last NPPES UpdateJuly 6, 20215 updates tracked since enumeration
NPPES CertifiedJuly 6, 2021
✔ NPI 1053802892 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
405 W COUNTRY CLUB RD, Roswell, NM 88201
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Other Identifiers 1

Medicaid23386363NM

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ruben A. Supan, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Ruben A. Supan, LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Kathleen Price, APRN - CNP
Nurse Practitioner
NPI 1225635808
405 W COUNTRY CLUB RD
Roswell, NM 88201
(575) 624-4777
✔ PECOS✔ Accepts Medicare0.7 mi
Ruben Supan, NP-C
Nurse Practitioner
NPI 1619392883
405 W COUNTRY CLUB RD
Roswell, NM 88201
(505) 409-0831
✔ PECOS0.7 mi
Babak Mirin, M.D.
Psychiatry
NPI 1891776274
3500 COMANCHE RD NE STE E6
Albuquerque, NM 87107
(505) 881-4500
✔ PECOS✔ Accepts Medicare167 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ruben A. Supan, LLC's NPI number?

The NPI number for Ruben A. Supan, LLC is 1053802892. It was assigned to this organization in the NPPES registry on May 29, 2018.

Where is Ruben A. Supan, LLC located?

Ruben A. Supan, LLC is located at 405 W Country Club Rd, Roswell, NM 88201. The listed phone number is (575) 363-3134.

What is Ruben A. Supan, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Ruben A. Supan, LLC enrolled in Medicare?

Yes. Ruben A. Supan, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ruben A. Supan, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Ruben A. Supan, LLC, in Nurse Practitioner and Psychiatry. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Ruben A. Supan, LLC was last updated on July 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.