DR. GILBERTO HEREDIA JR. M.D.
NPI 1649299942
Family Medicine in Albuquerque, NM

Q: What is Gilberto Heredia's NPI number?

The NPI number for Gilberto Heredia is 1649299942. It was assigned to this individual provider in the NPPES registry on July 18, 2006.

Q: What is Gilberto Heredia's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Gilberto Heredia was last updated on June 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months 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.

Active since July 18, 2006PECOS EnrolledAccepts Medicare Assignment

4901 LANG AVE NE, ALBUQUERQUE, NM 87109(505) 842-8171(505) 246-0684 Get Directions Write a Review

NPPES record last updated: June 12, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 12, 2025, Oct 17, 2019 (2 updates tracked since 2019).

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About Dr. Gilberto Heredia Jr. M.d. NPPES

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

DR. GILBERTO HEREDIA JR. M.D. (NPI 1649299942) is an individual family medicine provider in Albuquerque, New Mexico, licensed in New Mexico (98288) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Presbyterian Hospital, and is a graduate of Baylor College Of Medicine (1995).

NPPES Registry Identity

NPI1649299942

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. GILBERTO HEREDIA JR.Credential: M.D.

Location Address4901 LANG AVE NEAlbuquerque, NM 87109-4397

Mailing Address4901 Lang Ave NeAlbuquerque, NM 87109-4397 · (505) 842-8171 · Fax (505) 246-0684

Phone(505) 842-8171

Fax(505) 246-0684

Sole ProprietorNo

Medical School CMSBaylor College Of MedicineGraduated 1995

Enumeration DateJuly 18, 2006

Last NPPES UpdateJune 12, 20252 updates tracked since enumeration

NPPES CertifiedJune 12, 2025

✔ NPI 1649299942 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in NM · 98288

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

4901 LANG AVE NE, Albuquerque, NM 87109

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Other Identifiers 1

MedicaidS8635NM

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Gilberto Heredia Jr. M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4880590850

PECOS Enrollment IDI20051107000646

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

151 services71 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

63 services56 patients

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

32 services19 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

13 services13 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Presbyterian Hospital

Acute Care Hospitals · Albuquerque, NM

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number320021

Location1100 Central Avenue SEAlbuquerque, NM 87106 · Bernalillo County

Emergency services Birthing friendly

Cibola General Hospital

Critical Access Hospitals · Grants, NM

OwnershipVoluntary non-profit - Private

CMS Certification Number321308

Location1016 E Roosevelt AvenueGrants, NM 87020 · Cibola County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 87109 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.79 typical visit price

range $54.26 – $166.80

Typical copayment $21.19 (range $13.56 – $41.70)

Most-billed visit code 99203

Established Patient

$96.38 typical visit price

range $17.00 – $135.35

Typical copayment $24.09 (range $4.25 – $33.83)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

3 suppliers23 claims23 services$14.72 avg. paid by Medicare

Nebulizer, with compressor E0570

DME-Other DME · category DE000N

3 suppliers13 claims13 services$4.19 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

4 suppliers37 claims37 services$73.53 avg. paid by Medicare

Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing K0738

DME-Oxygen and Supplies · category DC000N

1 supplier12 claims12 services$34.89 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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