Optumcare New Mexico LLC
Organization Active NPI Family Medicine Physician · Albuquerque, NM
NPI 1124053210 · NPPES record last updated Mar 29, 2024
Key facts
- NPI
- 1124053210
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 32D0685327 (NM)
- Legal business name
- OPTUMCARE NEW MEXICO LLC
- Practice address
- 2901 Transport St SE
Albuquerque, NM 87106-4382 - Phone
- (505) 262-7000
- Fax
- (505) 262-7652
- NPI assigned
- Jul 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Emily Castillo
- Title
- Associate Director
- Phone
- (702) 480-2550
Member of 1
Practitioners 229
-
Denise E Aamodt, MD
-
Chidinma Anozie, MD
-
Melanie Jeanne Boone, NP-C
-
Katia Elizabeth Chavez, MD MPH
-
Rozita Dayani, CNP
-
Catherine Ann Delaney, PA-C
-
Annmarie Foley, FNP
-
Nishiena Gandhi, M.D.
-
Amanda Garcia, FNP-C
-
Dennis Garcia, MD
-
Michael Garcia, MD
-
Jeremy M Gleeson, MD
-
Jack J Greenberg, MD
-
Jeremy Richard Kersey, PA-C
-
April E Kimball, FNP-BC
-
Jerald T Loy, PA
-
Andi Danelle Martinez, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D0685329 | Optumcare New Mexico LLC Sunport | Certificate of waiver | Oct 25, 2027 |
| 32D2020535 | Optumcare New Mexico LLC Sunport Center for Pain | Certificate of waiver | Feb 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (20 enrollments) in NM, PA, MI, GA, AZ, WA, VA, CA, OK, FL, CO, TN, AL, NJ, OH, NY, IL, MA, MS, OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060302000704 | NM | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 120 practitioners Practice locations: Los Lunas, NM; Albuquerque, NM |
| O20220201002463 | PA | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 5 practitioners Practice locations: Penn Valley, PA; Philadelphia, PA |
| O20220228002521 | MI | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 2 practitioners Practice locations: Orchard Lake, MI; Troy, MI |
| O20220302000600 | GA | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Atlanta, GA |
| O20220303000104 | AZ | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Scottsdale, AZ |
| O20220304001221 | WA | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Seattle, WA |
| O20231212003887 | VA | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 2 practitioners Practice locations: Gainesville, VA; Virginia Beach, VA |
| O20231213001203 | CA | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Trabuco Canyon, CA |
| O20240214000659 | OK | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Mustang, OK |
| O20240308000189 | FL | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 4 practitioners Practice locations: Madeira Beach, FL; Naples, FL |
| O20240409000257 | CO | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Denver, CO |
| O20240426000508 | TN | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Chattanooga, TN |
| O20240513001739 | AL | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Vestavia, AL |
| O20240516002084 | NJ | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Sea Isle City, NJ |
| O20240606000760 | OH | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 2 practitioners Practice locations: Sylvania, OH |
| O20240617002474 | NY | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: New York, NY |
| O20241001001467 | IL | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Naperville, IL |
| O20251010000770 | MA | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: North Andover, MA |
| O20260312000788 | MS | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Biloxi, MS |
| O20260505000240 | OR | Part B Supplier - Clinic/Group Practice | 9032125810 |
Receives reassigned benefits from 1 practitioner Practice locations: Lake Oswego, OR |
National Provider Directory
Locations
2901 Transport St SE
Denver, CO 80291
4701 Montgomery Blvd NE
Ste 201
Albuquerque, NM 87109
Phone (505) 727-7778
4801 McMahon Blvd NW
Ste 250
Albuquerque, NM 87114
5051 Journal Center Blvd NE
Fl 2
Albuquerque, NM 87109
3901 Southern Blvd SE
Albuquerque, NM 87124
Phone (505) 896-8600
5310 Homestead Rd NE
Ste 102
Albuquerque, NM 87110
2121 Juan Tabo Blvd NE
Albuquerque, NM 87112
Phone (505) 237-8800
10511 Golf Course Rd NW
Ste 105
Albuquerque, NM 87114
Phone (505) 232-1100
500 Walter St NE
Ste 412
Albuquerque, NM 87102
Phone (505) 242-5222
5150 Journal Center Blvd NE
Fl 1
Albuquerque, NM 87109
Phone (505) 262-3233
500 Walter St NE
Ste 205
Albuquerque, NM 87102
Phone (505) 262-7223
10511 Golf Course Rd NW
Ste 103
Albuquerque, NM 87114
Phone (505) 232-1100
5041 Indian School Rd NE
Ste 400
Albuquerque, NM 87110
Phone (505) 255-3110
2211 Lomas Blvd NE
Fl 4
Albuquerque, NM 87106
Phone (505) 272-2245
500 Walter St NE
Ste 301
Albuquerque, NM 87102
Phone (505) 727-2850
2929 Coors Blvd NW
Ste 200
Albuquerque, NM 87120
Phone (505) 839-2300
715 Martin Luther King Ave NE
Ste 102
Albuquerque, NM 87102
Phone (505) 727-3040
211 Rio Bravo Blvd SW
Albuquerque, NM 87105
10511 Golf Course Rd NW
Ste 202
Albuquerque, NM 87114
Phone (505) 232-1150
4705 Montgomery Blvd NE
Ste 302
Albuquerque, NM 87109
Phone (505) 843-6168
4600 Jefferson Ln NE
Ste A
Albuquerque, NM 87109
Phone (505) 872-1002
4343 Pan American Fwy NE
Albuquerque, NM 87107
Phone (505) 389-4511
5150 Journal Center Blvd NE
Fl 2
Albuquerque, NM 87109
Phone (505) 232-1530
5041 Indian School Rd NE
Albuquerque, NM 87110
Phone (505) 727-3900
5150 Journal Center Blvd NE
Fl 3
Albuquerque, NM 87109
Phone (505) 262-3212
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 32D0685327 | NM | Yes |
Addresses
Primary practice location
2901 Transport St SE
Albuquerque, NM 87106-4382
Mailing address
PO Box 26028
Albuquerque, NM 87125-6028
Phone (505) 262-7000
Other names
- DaVita Medical Group
Other providers in Albuquerque, NM
- Optimum Counseling, LLC
- Option 1 Nutrition Solutions LLC
- Options Acupuncture
- Optum Behavioral Care of Ohio, Inc.
- Optumcare Endoscopy Center New Mexico, LLC
- Optumcare New Mexico, LLC
- Optumcare New Mexico, LLC
- Optumcare New Mexico, LLC
- Optumcare New Mexico, LLC
- Optumcare New Mexico, LLC
All providers in Albuquerque, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.