DAVITA MEDICAL GROUP
NPI 1124053210
Family Medicine in Albuquerque, NM

Q: What is Optumcare New Mexico LLC's NPI number?

The NPI number for Optumcare New Mexico LLC is 1124053210. It was assigned to this organization in the NPPES registry on July 11, 2006. The provider is doing business as Davita Medical Group.

Q: What is Optumcare New Mexico LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since July 11, 2006CLIA Certified · 8 labs

2901 TRANSPORT ST SE, ALBUQUERQUE, NM 87106(505) 262-7000(505) 262-7652 Get Directions Write a Review

NPPES record last updated: March 29, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 31, 2020, Aug 19, 2019, Feb 23, 2017 (3 updates tracked since 2017).

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About Davita Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DAVITA MEDICAL GROUP (NPI 1124053210) is a healthcare organization registered as a family medicine in Albuquerque, New Mexico and active in the NPI registry since July 2006. The organization holds 8 active CLIA laboratory certificates and lists Emily Castillo, Associate Director, as its authorized official.

NPPES Registry Identity

NPI1124053210

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameOPTUMCARE NEW MEXICO LLC

Location Address2901 TRANSPORT ST SEAlbuquerque, NM 87106-4382

Mailing AddressPo Box 26028Albuquerque, NM 87125-6028 · (505) 262-7000 · Fax (505) 262-7652

Phone(505) 262-7000

Fax(505) 262-7652

Organization SubpartNo

Authorized OfficialEmily CastilloAssociate Director · (702) 480-2550

Enumeration DateJuly 11, 2006

Last NPPES UpdateMarch 29, 20243 updates tracked since enumeration

NPPES CertifiedMarch 29, 2024

✔ NPI 1124053210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in NM · 32D0685327

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2901 TRANSPORT ST SE, Albuquerque, NM 87106

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Other Names 1

Doing Business AsDavita Medical Group

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 8

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 32D0685329

Optumcare New Mexico LLC Sunport · Albuquerque, NM

Active · expires Oct 25, 2027

CLIA Number32D0685329

Laboratory TypePhysician Office

Certificate Effective DateOctober 26, 2025

Certificate Expiration DateOctober 25, 2027

Laboratory DirectorDr. Kristy Rinkier

Laboratory Phone(505) 449-3332

Laboratory LocationOptumcare New Mexico LLC Sunport2901 Transport Street SE, Albuquerque, NM 87106

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 32D2020535

Optumcare New Mexico LLC Sunport Center For Pain Management · Albuquerque, NM

Active · expires Feb 21, 2027

CLIA Number32D2020535

Laboratory TypePhysician Office

Certificate Effective DateFebruary 22, 2025

Certificate Expiration DateFebruary 21, 2027

Laboratory DirectorMichael Malizzo

Laboratory Phone(505) 262-7724

Laboratory LocationOptumcare New Mexico LLC Sunport Center For Pain Management2901 Transport Street, Albuquerque, NM 87106

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 32D0685333

Optumcare New Mexico LLC Coors Hcc · Albuquerque, NM

Active · expires Jan 2, 2028

CLIA Number32D0685333

Laboratory TypePhysician Office

Certificate Effective DateJanuary 3, 2026

Certificate Expiration DateJanuary 2, 2028

Laboratory DirectorKristy Rinkier

Laboratory Phone(505) 702-7998

Laboratory LocationOptumcare New Mexico LLC Coors Hcc2929 Coors Blvd NW, Albuquerque, NM 87120

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 32D0685326

Optumcare New Mexico LLC Juan Tabo North Hcc · Albuquerque, NM

Active · expires Dec 31, 2027

CLIA Number32D0685326

Laboratory TypePhysician Office

Certificate Effective DateJanuary 1, 2026

Certificate Expiration DateDecember 31, 2027

Laboratory DirectorDonald Ortiz

Laboratory Phone(505) 237-8700

Laboratory LocationOptumcare New Mexico LLC Juan Tabo North Hcc2121 Juan Tabo NE, Albuquerque, NM 87112

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 32D1088217

Optumcare New Mexico LLC Midtown · Albuquerque, NM

Active · expires Nov 7, 2027

CLIA Number32D1088217

Laboratory TypePhysician Office

Certificate Effective DateNovember 8, 2025

Certificate Expiration DateNovember 7, 2027

Laboratory DirectorDon J. Ortiz

Laboratory Phone(505) 702-7998

Laboratory LocationOptumcare New Mexico LLC Midtown1821 Carlisle Blvd NE, Albuquerque, NM 87110

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 32D1037017

Optumcare New Mexico LLC Paseo Clinic · Albuquerque, NM

Active · expires Oct 4, 2027

CLIA Number32D1037017

Laboratory TypePhysician Office

Certificate Effective DateOctober 5, 2025

Certificate Expiration DateOctober 4, 2027

Laboratory DirectorDr. Kristy Rinkier

Laboratory Phone(505) 449-3332

Laboratory LocationOptumcare New Mexico LLC Paseo Clinic9501 Paseo Del Norte, Suite C, Albuquerque, NM 87122

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KENNETH A BELL DO

Internal Medicine