Individual provider Active NPI

Michael E Lentz, PAC

  • Medical Physician Assistant
  • Albuquerque, NM
National Provider Identifier
1770597510
Registry record updated Jul 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
83-PA009 Issued in NM
Practice address
5400 Gibson SE
Albuquerque, NM 87108
Phone
(505) 262-7594
Fax
(505) 262-7641
NPI assigned
Jul 28, 2006
Last updated
Jul 31, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 83-PA009 NM Primary

Addresses

Primary practice location

5400 Gibson SE
Albuquerque, NM 87108

Mailing address

5400 Gibson Blvd SE
Albuquerque, NM 87108-4729
Phone (505) 262-7960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
83-PA009NMMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare New Mexico LLC CurrentSince Nov 1, 2007 Accepting new patients
Optumcare Endoscopy Center New Mexico, LLC Past Accepting new patients

Locations

5150 Journal Center Blvd NE
Fl 3
Albuquerque, NM 87109
Phone (505) 262-3212

5400 Gibson Blvd SE
Albuquerque, NM 87108
Phone (505) 262-7174

Interoperability endpoints

  • Direct secure messaging: mlentz120987@westdirect.optum.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438300800000",
    "number": "1770597510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 GIBSON BLVD SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871084729",
            "telephone_number": "505-262-7960",
            "fax_number": "505-232-1368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 GIBSON SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87108",
            "telephone_number": "505-262-7594",
            "fax_number": "505-262-7641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENTZ",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2015-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NM",
            "license": "83-PA009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.