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DAVITA MEDICAL GROUP
NPI 1174025191
Durable Medical Equipment & Medical Supplies in Albuquerque, NM

Active since March 06, 2018CLIA Certified · 2 labs
5150 JOURNAL CENTER BLVD NE FL 2, ALBUQUERQUE, NM 87109(505) 232-1150 Get Directions Write a Review

NPPES record last updated: March 31, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 31, 2020, Sep 14, 2018, Mar 6, 2018 (3 updates tracked since 2018).

About Davita Medical Group NPPES

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

DAVITA MEDICAL GROUP (NPI 1174025191) is a healthcare organization registered as a durable medical equipment & medical supplies in Albuquerque, New Mexico and active in the NPI registry since March 2018. The organization holds 2 active CLIA laboratory certificates and lists Ryan Tyner, Cmo, as its authorized official.

NPPES Registry Identity

NPI1174025191
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameOPTUMCARE NEW MEXICO, LLC
Location Address5150 JOURNAL CENTER BLVD NE FL 2Albuquerque, NM 87109-5900
Mailing AddressPo Box 26028Albuquerque, NM 87125-6028 · (505) 232-1617
Phone(505) 232-1150
Organization SubpartYes
Authorized OfficialRyan TynerCmo · (505) 262-7000
Enumeration DateMarch 6, 2018
Last NPPES UpdateMarch 31, 20203 updates tracked since enumeration
NPPES CertifiedMarch 31, 2020
✔ NPI 1174025191 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
5150 JOURNAL CENTER BLVD NE FL 2, Albuquerque, NM 87109
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Other Names 1

Doing Business AsDavita Medical Group

CLIA Laboratory Certificates CMS CLIA 2

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 32D0685325

Optumcare New Mexico LLC Journal Center · Albuquerque, NM
Active · expires Oct 25, 2027
CLIA Number32D0685325
Laboratory TypePhysician Office
Certificate Effective DateOctober 26, 2025
Certificate Expiration DateOctober 25, 2027
Laboratory DirectorDonald Ortiz
Laboratory Phone(505) 702-7998
Laboratory LocationOptumcare New Mexico LLC Journal Center5150 Journal Center Blvd NE, Albuquerque, NM 87109
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 32D1070644

Optumcare New Mexico LLC Comprehensive Wellness Clinic · Albuquerque, NM
Active · expires Jul 4, 2027
CLIA Number32D1070644
Laboratory TypePhysician Office
Certificate Effective DateJuly 5, 2025
Certificate Expiration DateJuly 4, 2027
Laboratory DirectorRoderick K. Mcveety
Laboratory Phone(505) 702-7998
Laboratory LocationOptumcare New Mexico LLC Comprehensive Wellness Clinic4010 Montgomery Blvd NE, Albuquerque, NM 87109
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

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

DAVITA MEDICAL GROUP NEW MEXICO, LLC
Durable Medical Equipment & Medical Supplies
5150 JOURNAL CENTER BLVD NE FL 2
ALBUQUERQUE, NM 87109
Bernalillo County (505) 232-1530
GARY NELSON DPM
Podiatrist
5150 JOURNAL CENTER BLVD NE FL 2
ALBUQUERQUE, NM 87109
Bernalillo County (505) 232-1530
WILLIAM CHARLES SYME MD
Surgery
5150 JOURNAL CENTER BLVD NE FL 2
ALBUQUERQUE, NM 87109
Bernalillo County (505) 232-1572
LISA MARIE TAYLOR
Nurse Practitioner (Family)
5150 JOURNAL CENTER BLVD NE FL 2
ALBUQUERQUE, NM 87109
Bernalillo County (505) 262-7455
KATHY JEAN O'CONNOR MD
Internal Medicine
5150 JOURNAL CENTER BLVD NE FL 2
ALBUQUERQUE, NM 87109
Bernalillo County (505) 262-3212

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Optumcare New Mexico, LLC's NPI number?

The NPI number for Optumcare New Mexico, LLC is 1174025191. It was assigned to this organization in the NPPES registry on March 6, 2018. The provider is doing business as Davita Medical Group.

Where is Optumcare New Mexico, LLC located?

Optumcare New Mexico, LLC is located at 5150 Journal Center Blvd NE Fl 2, Albuquerque, NM 87109. The listed phone number is (505) 232-1150.

What is Optumcare New Mexico, LLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Does Optumcare New Mexico, LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Optumcare New Mexico, LLC was last updated on March 31, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.