NPIMap

Organization Active NPI

Lovelace Unm Rehabilitation Hospital LLC

  • Speech-Language Pathologist
  • Jemez Pueblo, NM
National Provider Identifier
1104357003
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
LOVELACE UNM REHABILITATION HOSPITAL LLC
Practice address
129 A Canal Street
Jemez Pueblo, NM 87024
Phone
(575) 834-9168
Fax
(575) 834-0238
NPI assigned
Mar 22, 2017
Organization subpart
Yes
Parent organization
ARDENTH HEALTH PARTNERS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

Authorized official

Name
Stephen C Petrovich
Title
Evp
Phone
(615) 296-3000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

129 A Canal Street
Jemez Pueblo, NM 87024

Mailing address

1 Burton Hills Blvd
Suite 250
Nashville, TN 37215-6293
Phone (615) 296-3000

Other names 1

  • Lovelace UNM Outpatient Rehabilitation at Jemez Pueblo Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170424000991 NM Part B Supplier - Clinic/Group Practice 5799061917 Receives reassigned benefits from 38 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albuquerque, NM; Jemez Pueblo, NM; Santa Fe, NM; Rio Rancho, NM

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lovelace Unm Rehabilitation Hospital LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1104357003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BURTON HILLS BLVD",
            "address_2": "SUITE 250",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156293",
            "telephone_number": "615-296-3000",
            "fax_number": "615-296-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 A CANAL STREET",
            "city": "JEMEZ PUEBLO",
            "state": "NM",
            "postal_code": "87024",
            "telephone_number": "575-834-9168",
            "fax_number": "575-834-0238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOVELACE UNM REHABILITATION HOSPITAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARDENTH HEALTH PARTNERS LLC",
        "enumeration_date": "2017-03-22",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lovelace UNM Outpatient Rehabilitation at Jemez Pueblo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jemez Pueblo, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.