NPIMap

Organization Active NPI

Lovelace Health System LLC

  • Body Imaging Physician
  • Albuquerque, NM
National Provider Identifier
1902084809
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
LOVELACE HEALTH SYSTEM LLC
Practice address
10501 Golf Course Rd NW
Albuquerque, NM 87114-5019
Phone
(505) 727-2000
Fax
(505) 727-9568
NPI assigned
Feb 4, 2008
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
Mr. Stephen C Petrovich
Title
SVP
Phone
(615) 296-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X Primary

Addresses

Primary practice location

10501 Golf Course Rd NW
Albuquerque, NM 87114-5019

Mailing address

10501 Golf Course Rd NW
Albuquerque, NM 87114-5019
Phone (505) 727-2000

Other names 1

  • Lovelace Westside Hospital 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

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1902084809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10501 GOLF COURSE RD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145019",
            "telephone_number": "505-727-2000",
            "fax_number": "505-727-9568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10501 GOLF COURSE RD NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145019",
            "telephone_number": "505-727-2000",
            "fax_number": "505-727-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOVELACE HEALTH SYSTEM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ARDENT LEGACY HOLDINGS, LLC",
        "enumeration_date": "2008-02-04",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lovelace Westside Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lovelace Westside Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 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.