MAYEDEL A SAN JOSE PC
NPI 1083305510
Nurse Practitioner - Family in Santa Teresa, NM
About Mayedel A San Jose Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MAYEDEL A SAN JOSE PC (NPI 1083305510), doing business as San Jose Wellness Center, is a healthcare organization registered as a family in Santa Teresa, New Mexico and active in the NPI registry since May 2023. The organization lists Mayedel San Jose, Owner/president, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mayedel A San Jose Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Mayedel A San Jose PC, which bills Medicare for the services this clinician delivers.
Clinician (1)
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 Mayedel A San Jose PC's NPI number?
The NPI number for Mayedel A San Jose PC is 1083305510. It was assigned to this organization in the NPPES registry on May 16, 2023. The provider is doing business as San Jose Wellness Center.
Where is Mayedel A San Jose PC located?
Mayedel A San Jose PC is located at 5290 Mcnutt Rd Ste 103, Santa Teresa, NM 88008. The listed phone number is (575) 230-1200.
What is Mayedel A San Jose PC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Mayedel A San Jose PC enrolled in Medicare?
Yes. Mayedel A San Jose PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mayedel A San Jose PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Mayedel A San Jose PC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Mayedel A San Jose PC was last updated on October 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 days 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.
# Mayedel A San Jose Pc · NPI 1083305510
Family organization in Santa Teresa, New Mexico. Organization record, active in the CMS NPPES registry since May 16, 2023.
## Identity
- **NPI:** 1083305510 (Entity type: Organization)
- **Enumerated:** May 16, 2023
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Also known as:** San Jose Wellness Center (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Mayedel San Jose, OWNER/PRESIDENT
## Practice location
- **Address:** 5290 MCNUTT RD STE 103, Santa Teresa, NM 88008-9648
- **Phone:** (575) 230-1200 · **Fax:** (818) 337-1474
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 18, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1083305510) · Data from the CMS NPPES public registry.