Active NPI
Bruce Lundblad, DO
- Family Medicine Physician
- Albuquerque, NM
National Provider Identifier
1619902731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A-897-89
- Practice address
- 5150 Journal Center Blvd NE
Albuquerque, NM 87109-5900 - Phone
- (505) 262-3233
- Fax
- (505) 262-3191
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A-897-89 | NM | Primary |
Addresses
Primary practice location
5150 Journal Center Blvd NE
Albuquerque, NM 87109-5900
Mailing address
PO Box 27829
Albuquerque, NM 87125
Phone (505) 232-1920
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18119 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-897-89 | NM | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optumcare Endoscopy Center New Mexico, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Albuquerque, NM
- NPI 1962685834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315267200000",
"number": "1619902731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 27829",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87125",
"telephone_number": "505-232-1920",
"fax_number": "505-727-9276"
},
{
"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": "505-262-3233",
"fax_number": "505-262-3191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDBLAD",
"first_name": "BRUCE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2011-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NM",
"license": "A-897-89",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18119",
"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 Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.