OMNI MEDICAL GROUP LLC (NPI# 1568768042) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568768042 |
| Entity Type | Organization |
| Organization Name | OMNI MEDICAL GROUP LLC |
| Other Organization Name | CLINICA LA ESPERANZA |
| Practice Address |
4201 Central Ave Nw K3 Albuquerque NM 87105-1630 |
| Mailing Address |
4201 Central Ave Nw Ste K3 Albuquerque NM 87105-1630 |
| Practice Telephone | 5057171685 |
| Mailing Telephone | 5055081739 |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2015-01-19 |
| Authorized Official Name | MR. OLENA DZIUBA (CFO) |
| Authorized Official Telephone | 5055732495 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | 6556 | NM | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA20030032 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 5126223 | 05 |
| Other Name | Type Code |
|---|---|
| Clinica La Esperanza | Doing Business As Name - Organization |
| Street Address |
4201 CENTRAL AVE NW K3 |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87105-1630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508847567 | Frances Kathleen Lopez-bushnell | Nurse Practitioner | 4201 Central Ave Nw, Ste K3, Albuquerque, NM 87105-1630 | 2005-11-08 |
| 1306406772 | Juleini M Meneses | Dentist | 4201 Central Ave Nw, Albuquerque, NM 87105-1630 | 2019-06-18 |
| 1740635846 | Cade Clinical Consulting LLC | Nurse Practitioner | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2016-04-27 |
| 1083000699 | Renal and Internal Medicine Consultant PC | Internal Medicine | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2015-04-09 |
| 1699161216 | Turquoise Mesa LLC | Nurse Practitioner | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2015-04-09 |
| 1104174168 | Elly Bunsun Kim | Dentist | 4201 Central Ave Nw, Albuquerque, NM 87105-1630 | 2012-08-24 |
| 1124374004 | Julianne Austin | Family Medicine | 4201 Central Ave Nw, Suite K2, Albuquerque, NM 87105-1630 | 2012-07-30 |
| 1356633432 | Family Smiles, LLC | Dentist | 4201 Central Ave Nw, F-1, Albuquerque, NM 87105-1630 | 2011-05-09 |
| 1427280767 | Milagro Physical Therapy, LLC | Physical Therapist | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2009-08-20 |
| 1962567883 | Ramon Rosa Duarte | Internal Medicine | 4201 Central Ave Nw, Suite K-2, Albuquerque, NM 87105-1630 | 2006-12-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588278063 | Jacob Hill | Rehabilitation Practitioner | 2001-b El Centro Familiar Blvd Se, Albuqerque, NM 87105 | 2020-09-02 |
| 1083264824 | Kacie Rhodes | Technician | 515 Isleta Blvd Sw, Albuquerque, NM 87105 | 2019-09-13 |
| 1043870454 | Equal LLC | Assisted Living Facility | 207 Lagunitas Lane, Albuquerque, NM 87105 | 2019-06-18 |
| 1043792997 | Elizabeth Bennett | Counselor | 309 59th St Nw, Albuquerque, NM 87105 | 2018-09-06 |
| 1316439920 | Deann Nieto | Rehabilitation Practitioner | 2001b El Centro Familiar Blvd Sw, Albuquerque, NM 87105 | 2018-05-31 |
| 1487163457 | Karen Bejarano | Behavior Technician | 1847 Val Verde Rd Sw, Albuquerque, NM 87105 | 2017-09-21 |
| 1306360391 | Bendiciones Home Health Care | Home Health | 5500 Cleo Rd. Sw, Albuquerque, NM 87105 | 2017-08-01 |
| 1578927711 | Clarence Mills | Counselor | 1528 Five Points Rd Nw, Albuquerque, NM 87105 | 2016-04-13 |
| 1386024727 | Rachel Elaine Kadetz | Counselor | 1101 Lopez Rd. Sw, Albuquerque, NM 87105 | 2015-06-01 |
| 1598160772 | Sandra Jean Taylor | Lactation Consultant, Non-RN | 1305 Blake Rd Sw, Albuquerque, NM 87105 | 2014-10-30 |
| Find all providers in zip 87105 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295350437 | Clinica Para Todos | Clinic/Center | 7345 Yorktown Ave Ne, Albuquerque, NM 87109-5070 | 2020-06-13 |
| 1285260588 | Uptown Dermatology LLC | Clinic/Center | 8016 Constitution Pl Ne, Albuquerque, NM 87110-7628 | 2020-03-18 |
| 1083188585 | Hearing and Vision Store | Clinic/Center | 8400 Menaul Blvd Ne Ste F, Albuquerque, NM 87112-2200 | 2019-01-17 |
| 1144733924 | Heights Family Wellness Center LLC | Clinic/Center | 5800 Mcleod Rd Ne Ste C, Albuquerque, NM 87109-2467 | 2017-11-14 |
| 1316303647 | Southwest Care Center | Clinic/Center | 4710 Jefferson St Ne Ste A, Albuquerque, NM 87109-2156 | 2015-12-31 |
| 1568842953 | The Human Body Shop | Clinic/Center | 617 Solano Dr Se, Albuquerque, NM 87108-3380 | 2015-06-01 |
| 1356736573 | Visionquest Irb | Clinic/Center | 2501 Yale Blvd Se, Suite 301, Albuquerque, NM 87106-4200 | 2015-04-03 |
| 1235531468 | Health Quest Wellness Central LLC | Clinic/Center | 723 Silver Ave Sw Ste L1, Albuquerque, NM 87102-3018 | 2014-09-18 |
| 1033547302 | Health Quest Wellness Cottonwood LLC | Clinic/Center | 9664 Eagle Ranch Rd Nw Ste A-1, Albuquerque, NM 87114-1578 | 2013-10-24 |
| 1598058232 | Over The Edge Group Home for Disable | Clinic/Center | 7010 Phoenix Ave Ne Apt 310, Albuquerque, NM 87110-3505 | 2011-05-26 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87105 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.