Optumcare New Mexico, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

OPTUMCARE NEW MEXICO, LLC

Doing business as

DaVita Medical Group

Practice address

5150 Journal Center Blvd NE FL 2
Albuquerque, NM 87109-5900

Phone

(505) 232-1150

NPI assigned

Mar 6, 2018

Last updated

Mar 31, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

OPTUMCARE NEW MEXICO, LLCAs reported in NPPES

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

Authorized official

Name

Ryan TynerNPI 1003092701

Title

Cmo

Phone

(505) 262-7000

Specialties & licenses 1

Addresses

Other names 1

• DaVita Medical Group Doing business as

Part of

Lovelace Healthcare Center-Santa Fe

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan P. Tyner, M.D.

  • Surgery Physician
  • Albuquerque, NM
  • NPI 1003092701
  Authorized official Same address or phone

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

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585612800000",
    "number": "1174025191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26028",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256028",
            "telephone_number": "505-232-1617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 JOURNAL CENTER BLVD NE FL 2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095900",
            "telephone_number": "505-232-1150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE NEW MEXICO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTUMCARE NEW MEXICO, LLC",
        "enumeration_date": "2018-03-06",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A",
        "authorized_official_last_name": "TYNER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "505-262-7000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Or Psychiatry LLC

• Durable Medical Equipment & Medical Supplies in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Durable Medical Equipment & Medical Supplies in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.