OPTUMCARE NEW MEXICO, LLC (NPI# 1174025191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174025191 |
| Entity Type | Organization |
| Organization Name | OPTUMCARE NEW MEXICO, LLC |
| Other Organization Name | DAVITA MEDICAL GROUP |
| Practice Address |
5150 Journal Center Blvd Ne Fl 2 Albuquerque NM 87109-5900 |
| Mailing Address |
Po Box 26028 Albuquerque NM 87125-6028 |
| Practice Telephone | 5052321150 |
| Mailing Telephone | 5052321617 |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2020-03-31 |
| Authorized Official Name | RYAN TYNER (CMO) |
| Authorized Official Telephone | 5052627000 |
| Is Organization Subpart | Y |
| Parent Organization Name | OPTUMCARE NEW MEXICO, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| Other Name | Type Code |
|---|---|
| DaVita Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588947485 | Optumcare New Mexico, LLC | Eyewear Supplier (Equipment, not the service) | 5150 Journal Center Blvd Ne, Albuquerque, NM 87109-5900 | 2011-09-27 |
| 1326338963 | Optumcare New Mexico, LLC | Nurse Practitioner | 5400 Gibson Blvd Se, Albuquerque, NM 87108-4729 | 2011-04-17 |
| 1245494723 | Optumcare New Mexico, LLC | Radiologic Technologist | 5150 Journal Center Blvd Ne, Albuquerque, NM 87109-5900 | 2008-07-15 |
| 1851497663 | Optumcare New Mexico, LLC | General Practice | 4700 Jefferson St Ne, Suite 800, Albuquerque, NM 87109-2136 | 2006-09-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | OPTUMCARE NEW MEXICO, LLC | 534 Butte Ave, Pacific, WA 98047-1413 |
| Street Address |
5150 JOURNAL CENTER BLVD NE FL 2 |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87109-5900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407850340 | Jeffrey P Beckenbaugh | Orthopaedic Surgery | 5150 Journal Center Blvd Ne Fl 2, Albuquerque, NM 87109-5900 | 2005-06-09 |
| 1083197032 | Davita Medical Group New Mexico, LLC | Durable Medical Equipment & Medical Supplies | 5150 Journal Center Blvd Ne Fl 2, Albuquerque, NM 87109-5900 | 2018-09-14 |
| 1548513716 | Lisa Marie Taylor | Nurse Practitioner | 5150 Journal Center Blvd Ne Fl 2, Albuquerque, NM 87109-5900 | 2012-10-24 |
| 1679584684 | Kathy Jean O'connor | Internal Medicine | 5150 Journal Center Blvd Ne Fl 2, Albuquerque, NM 87109-5900 | 2006-08-11 |
| 1457374555 | William Charles Syme | Surgery | 5150 Journal Center Blvd Ne Fl 2, Albuquerque, NM 87109-5900 | 2006-07-26 |
| 1447273552 | Gary Nelson | Podiatrist | 5150 Journal Center Blvd Ne Fl 2, Albuquerque, NM 87109-5900 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386286367 | Mikaela Epaloose | Behavior Technician | 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-10-11 |
| 1245872464 | Marsha Director | Behavior Technician | 100 Sun Avenue Ne, Ste 650, Albuquerque, NM 87109 | 2019-10-09 |
| 1720637499 | Nancy Gail Vice | Technician | 7319 Laguna Niguel Drive Ne, Albuquerque, NM 87109 | 2019-09-05 |
| 1598314411 | Chau Vu | Behavior Technician | Attn: Behavioral Health Works 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-09-04 |
| 1932753498 | Noelle Nielsen | Behavior Technician | 6401 Academy Rd. Ne Apt. 189, Albuquerque, NM 87109 | 2019-08-01 |
| 1952967952 | Caridad Merkel | Obstetrics & Gynecology | 6100 Pan American Fwy Ne Suite 450, Albuquerque, NM 87109 | 2019-05-15 |
| 1043795149 | Margaret Mcconville | Physical Therapist | Lovelace Women's Hospital Outpatient Rehabilitation, 4600 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-09-25 |
| 1922586262 | Clark Endodontics LLC | Dentist | 7520 Montgomery Blvd Ne Bldg E1, Albuquerque, NM 87109 | 2018-07-30 |
| 1447736202 | Melissa Christine Scott | Registered Nurse | Lovelace Women's Hospital, 4701 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-07-16 |
| 1508351990 | Gianna Nicole Casarez-quintana | Dentist | 7520 Montgomery Blvd Ne Bldg E10, Albuquerque, NM 87109 | 2018-06-27 |
| Find all providers in zip 87109 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235788100 | Eric J Rico | Durable Medical Equipment & Medical Supplies | 2001 Mountain Rd Nw Ste F2, Albuquerque, NM 87104-1484 | 2019-09-04 |
| 1801376942 | Supercare, Inc. | Durable Medical Equipment & Medical Supplies | 9420 San Mateo Blvd Ne Ste C, Albuquerque, NM 87113-1400 | 2018-08-17 |
| 1750875621 | Home Medical Equipment Specialists, LLC | Durable Medical Equipment & Medical Supplies | 3901 Masthead St Ne, Albuquerque, NM 87109-4481 | 2018-06-14 |
| 1689186868 | Crandall Medical | Durable Medical Equipment & Medical Supplies | 4924 Wellsburg Ave Nw, Albuquerque, NM 87120-3801 | 2017-10-28 |
| 1841711553 | Bernalillo Health Supplies | Durable Medical Equipment & Medical Supplies | 500 Marquette Avenue 500 Marquette Avenue Suite 1200, Albuquerque, NM 87102 | 2017-07-03 |
| 1407396989 | Strive Medical LLC | Durable Medical Equipment & Medical Supplies | 2655 Pan American Fwy Ne, Ste G, Albuquerque, NM 87107-1639 | 2017-03-02 |
| 1831563238 | 180 Medical, Inc. | Durable Medical Equipment & Medical Supplies | 5620 San Francisco Rd Ne Ste A, Albuquerque, NM 87109-4656 | 2015-11-23 |
| 1477920882 | Modern Creations Construction | Durable Medical Equipment & Medical Supplies | 9716 Torriso Ct Sw, Albuquerque, NM 87121-5280 | 2015-09-02 |
| 1457734253 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 1820 Unser Blvd Nw, Albuquerque, NM 87120-3933 | 2015-06-30 |
| 1538564877 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 11018 Montgomery Blvd Ne, Albuquerque, NM 87111-3962 | 2014-10-29 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87109 |
Please comment or provide details below to improve the information on OPTUMCARE NEW MEXICO, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.