NPIMap

Organization Active NPI

Old Pueblo Healthcare LLC

Doing business as Optima Medical

  • Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1306890793
Registry record updated Jun 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN069526 Issued in AZ
Legal business name
OLD PUEBLO HEALTHCARE LLC
Doing business as
Optima Medical
Practice address
5981 E Grant Rd
Suite 115
Tucson, AZ 85712
Phone
(520) 886-5315
Fax
(520) 298-8201
NPI assigned
May 20, 2006
Last updated
Jun 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2020

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

Authorized official

Name
Michael O'Neil
Title
Ceo
Phone
(480) 660-6706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X RN069526 AZ Primary

Addresses

Primary practice location

5981 E Grant Rd
Suite 115
Tucson, AZ 85712

Mailing address

5981 E Grant Rd
Suite 115
Tucson, AZ 85712
Phone (520) 886-5315

Other identifiers 1

IdentifierTypeStateIssuer
101738MedicaidAZ

Other names 1

  • OPTIMA MEDICAL Doing business as

National Provider Directory

National Provider Directory

Locations

1760 E Florence Blvd
Casa Grande, AZ 85122
Phone (520) 836-4868

8914 N 91st Ave
Ste 100A
Peoria, AZ 85345
Phone (623) 877-0100

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1306890793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5981 E GRANT RD",
            "address_2": "SUITE 115",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85712",
            "telephone_number": "520-886-5315",
            "fax_number": "520-298-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5981 E GRANT RD",
            "address_2": "SUITE 115",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85712",
            "telephone_number": "520-886-5315",
            "fax_number": "520-298-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD PUEBLO HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "O'NEIL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-660-6706"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "RN069526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101738",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OPTIMA MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OPTIMA MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.