NPIMap

Organization Active NPI

Lovelace Health System Inc

Doing business as Lovelace Regional Hospital Family and Urgent Care Center

  • Family Medicine Physician
  • Roswell, NM
National Provider Identifier
1316213606
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LOVELACE HEALTH SYSTEM INC
Doing business as
Lovelace Regional Hospital Family and Urgent Care Center
Practice address
2335 N Main St
Roswell, NM 88201-6452
Phone
(575) 622-4665
Fax
(575) 622-4557
NPI assigned
Mar 30, 2012
Last updated
May 29, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
ARDENT LEGACY HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2019

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NM Primary

Addresses

Primary practice location

2335 N Main St
Roswell, NM 88201-6452

Mailing address

2335 N Main St
Roswell, NM 88201-6452
Phone (575) 622-4665

Other identifiers 1

IdentifierTypeStateIssuer
7707576MedicaidNM

Other names 1

  • Lovelace Regional Hospital Family and Urgent Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031210000397 NM Part B Supplier - Clinic/Group Practice 9739099326 Receives reassigned benefits from 65 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Fe, NM; Roswell, NM; Albuquerque, NM

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1316213606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2335 N MAIN ST",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882016452",
            "telephone_number": "575-622-4665",
            "fax_number": "575-622-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 N MAIN ST",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882016452",
            "telephone_number": "575-622-4665",
            "fax_number": "575-622-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOVELACE HEALTH SYSTEM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARDENT LEGACY HOLDINGS, LLC",
        "enumeration_date": "2012-03-30",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "PETROVICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SVP",
        "authorized_official_telephone_number": "615-296-3000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7707576",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lovelace Regional Hospital Family and Urgent Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lovelace Regional Hospital Family and Urgent Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; 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.