NPIMap

Organization Active NPI

Optumcare New Mexico, LLC

Doing business as DaVita Medical Group

  • Radiologic Technologist
  • Albuquerque, NM
National Provider Identifier
1245494723
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiologic TechnologistTaxonomy code 247100000X
Legal business name
OPTUMCARE NEW MEXICO, LLC
Doing business as
DaVita Medical Group
Practice address
5150 Journal Center Blvd NE
Albuquerque, NM 87109-5900
Phone
(505) 232-1500
Fax
(505) 232-1584
NPI assigned
Jul 15, 2008
Last updated
Aug 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

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

Authorized official

Name
John G Liethen
Title
Secretary
Phone
(952) 205-6262

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular-Interventional Technology Radiologic Technologist 2471V0106X NU
Radiologic Technologist 247100000X NU Primary
Bone Densitometry Radiologic Technologist 2471B0102X NU
Computed Tomography Radiologic Technologist 2471C3401X NU
Radiography Radiologic Technologist 2471C3402X NU
Magnetic Resonance Imaging Radiologic Technologist 2471M1202X NU
Mammography Radiologic Technologist 2471M2300X NU
Sonography Radiologic Technologist 2471S1302X NU
Vascular Sonography Radiologic Technologist 2471V0105X NU

Addresses

Primary practice location

5150 Journal Center Blvd NE
Albuquerque, NM 87109-5900

Mailing address

PO Box 26028
Albuquerque, NM 87125-6028
Phone (505) 232-1500

Other identifiers 1

IdentifierTypeStateIssuer
93670567MedicaidNM

Other names 1

  • DaVita Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lovelace Healthcare Center-Santa Fe24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1216080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1245494723",
    "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": "505-232-1500",
            "fax_number": "505-232-1584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 JOURNAL CENTER BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095900",
            "telephone_number": "505-232-1500",
            "fax_number": "505-232-1584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE NEW MEXICO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-15",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "LIETHEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-205-6262"
    },
    "taxonomies": [
        {
            "code": "2471V0106X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Vascular-Interventional Technology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2471B0102X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Bone Densitometry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471C3401X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Computed Tomography",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471C3402X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Radiography",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471M2300X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Mammography",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471S1302X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Sonography",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2471V0105X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Vascular Sonography",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93670567",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.