Individual provider Active NPI

Tara Lynn Dupont, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1104047265
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
MD2011-0413 Issued in NM
Practice address
2211 Lomas Blvd NE
Albuquerque, NM 87106-2745
Phone
(505) 272-5437
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X M8636 TX
Neonatal-Perinatal Medicine Physician 2080N0001X MD2011-0413 NM Primary

Addresses

Primary practice location

2211 Lomas Blvd NE
Albuquerque, NM 87106-2745

Mailing address

933 Bradbury Dr SE
Suite 2222
Albuquerque, NM 87106-4374
Phone (505) 272-3120

Other names 1

  • Tara Lynn Sullivan Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tdupont324761@direct.med.utah.edu Direct UNIVERSITY OF UTAH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, UT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111013000613 NM Practitioner - Pediatric Medicine 2567634637 Reassigns benefits to 1 organization
I20190204003063 UT Practitioner - Pediatric Medicine 2567634637 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2011-0413NMMDNeonatal-Perinatal Medicine Physician
M8636TXMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Pediatric Acuity Care CurrentSince Oct 18, 2018 Accepting new patients
Ihc Health Services Inc CurrentSince Jan 31, 2019 Accepting new patients
Unm Medical Group Inc CurrentSince Aug 19, 2011 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Ihc Health Services, Inc. CurrentSince Jan 31, 2019 Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince Oct 18, 2018 Accepting new patients
University of Utah Pediatric Acuity Care Current Accepting new patients
Unm Medical Group, Inc. CurrentSince Aug 19, 2011 Accepting new patients
University of Utah Pediatric Acuity Care Neonatal-Perinatal Medicine Past Accepting new patients

Locations

933 Bradbury Dr SE
Ste 2222
Albuquerque, NM 87106
Phone (505) 272-1476

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

127 S 500 E
Ste 200
Salt Lake City, UT 84102

5121 S Cottonwood St
Ste 100
Salt Lake City, UT 84107
Phone (801) 507-7400

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Interoperability endpoints

  • Direct secure messaging: tdupont173233@ahs.direct-ci.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1104047265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 BRADBURY DR SE",
            "address_2": "SUITE 2222",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064374",
            "telephone_number": "505-272-3120",
            "fax_number": "505-272-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 LOMAS BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871062745",
            "telephone_number": "505-272-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUPONT",
        "first_name": "TARA",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "TX",
            "license": "M8636",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NM",
            "license": "MD2011-0413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdupont324761@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "SULLIVAN",
            "middle_name": "LYNN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.