NPIMap

Organization Active NPI

Omnisleep LLC

  • Sleep Disorder Diagnostic Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1508093469
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Disorder Diagnostic Clinic/CenterTaxonomy code 261QS1200X
Legal business name
OMNISLEEP LLC
Practice address
3810 Masthead St NE
Albuquerque, NM 87109-4479
Phone
(505) 843-8758
Fax
(505) 843-9269
NPI assigned
Jun 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Authorized official

Name
Mr. John Craig EavesNPI 1437147899
Title
Ceo
Phone
(505) 843-8758

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS1201X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X
Pediatric Sleep Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080S0012X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Sleep Disorder Diagnostic Clinic/Center 261QS1200X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X

Addresses

Primary practice location

3810 Masthead St NE
Albuquerque, NM 87109-4479

Mailing address

3810 Masthead St NE
Albuquerque, NM 87109-4479
Phone (505) 843-8758

Other identifiers 1

IdentifierTypeStateIssuer
95877321MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091216000439 NM Part B Supplier - Clinic/Group Practice 1658303987 Receives reassigned benefits from 14 practitioners
Practice locations: Albuquerque, NM

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

3810 Masthead St NE
Albuquerque, NM 87109
Phone (505) 243-3514

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1508093469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 MASTHEAD ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094479",
            "telephone_number": "505-843-8758",
            "fax_number": "505-843-9269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 MASTHEAD ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094479",
            "telephone_number": "505-843-8758",
            "fax_number": "505-843-9269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNISLEEP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "EAVES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-843-8758",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QS1201X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95877321",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 7, 2024; 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.