Dirk Bradley Bahoravitch (NPI# 1184083826, PAC ID# 0941595441) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA).
| Nation Provider ID (NPI) | 1184083826 |
| PAC ID by PECOS | 0941595441 |
| Professional Enrollment ID | I20190917003288 |
| Full Name | Dirk Bradley Bahoravitch |
| Organization Legal Name | MAIN STREET ANESTHESIA OF NEW MEXICO, LLC |
| Address |
504 Elm St Ne Heart Hospital of New Mexico Albuquerque NM 87102-2512 |
| Phone Number | 5057271100 |
| Gender | M |
| Graduation Year | 2011 |
| Primary Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| Group Practice PAC ID | 3476807538 |
| Number of Group Practice Members | 75 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130002 | ST LUKES MAGIC VALLEY MEDICAL CENTER |
| 320009 | LOVELACE MEDICAL CENTER |
| 320017 | LOVELACE WOMEN'S HOSPITAL |
| 320074 | LOVELACE WESTSIDE HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 | 5057271100 | MAIN STREET ANESTHESIA OF NEW MEXICO, LLC |
| 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 | 5057278000 | MAIN STREET ANESTHESIA OF NEW MEXICO, LLC |
| Organization Legal Name | MAIN STREET ANESTHESIA OF NEW MEXICO, LLC |
| Physicians | 48 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Randall A Hamilton | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 117 E 19th St, Lovelace Regional Hospital Roswell, Roswell, NM 88201-5151 |
| Tara L Orr | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Michael Arthur Anderson | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Laura Bauders | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Elliot S Marcus | Anesthesiology | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Douglas L Brown | Anesthesiology | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Jarrod A Russo | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Paul Jeffrey Butler | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Timothy M Candelaria | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Lee W Harper | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 601 Dr Martin Luther King Jr Ave Ne, Lovelace Medical Center, Albuquerque, NM 87102-3619 |
| Street Address |
504 ELM ST NE HEART HOSPITAL OF NEW MEXICO |
| City | ALBUQUERQUE |
| State | NM |
| Zip | 87102-2512 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bradley Richardson | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 |
| Daniel G Berson | Anesthesiology | Main Street Anesthesia of New Mexico, LLC | 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 |
| Jeffrey M Dorf | Pulmonary Disease | Chest Medicine of New Mexico PC | 504 Elm St Ne, Heart Hospital of Nm, Albuquerque, NM 87102-2512 |
| Lia A Pulido | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 |
| Michael M Steele | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 |
| Cory J Hicks | Pulmonary Disease | Chest Medicine of New Mexico PC | 504 Elm St Ne, Heart Hospital of Nm, Albuquerque, NM 87102-2512 |
| Brent Butner | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 |
| Cody Randy Charlton | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 |
| Megan Hilgenberg | Certified Registered Nurse Anesthetist (crna) | Main Street Anesthesia of New Mexico, LLC | 504 Elm St Ne, Heart Hospital of New Mexico, Albuquerque, NM 87102-2512 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Justin Richard White | Nurse Practitioner | Lovelace Health System LLC | 601 Martin Luther King Jr Ave Ne, Albuquerque, NM 87102 |
| Amanda G Wilder | Clinical Social Worker | 200 Rosemont Ave Ne, Albuquerque, NM 87102-1569 | |
| Rachel L Rogers | Clinical Social Worker | 200 Rosemont Ave Ne, Suite D, Albuquerque, NM 87102-1599 | |
| Elaine K Padilla | Clinical Social Worker | Outcomes Inc | 1503 University Blvd Ne, Albuquerque, NM 87102-1708 |
| Kathryn Fehr | Clinical Social Worker | Outcomes Inc | 1503 University Blvd Ne, Albuquerque, NM 87102-1708 |
| Daniel Crowder | Clinical Social Worker | Outcomes Inc | 1503 University Blvd Ne, Albuquerque, NM 87102-1708 |
| Claire Greene | Clinical Social Worker | Outcomes Inc | 1503 University Blvd Ne, Albuquerque, NM 87102-1708 |
| Scott S Stoerner | Rheumatology | Albuquerque Center for Rheumatology PC | 1617 University Blvd Ne, Albuquerque, NM 87102-1710 |
| Jacqueline K Dean | Rheumatology | Albuquerque Center for Rheumatology PC | 1617 University Blvd Ne, Albuquerque, NM 87102-1710 |
| Leroy A Pacheco | Rheumatology | Albuquerque Center for Rheumatology PC | 1617 University Blvd Ne, Albuquerque, NM 87102-1710 |
| Find all physicians in zip 87102 | |||
| City | ALBUQUERQUE |
| Zip Code | 87102 |
| Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| City + Specialty | ALBUQUERQUE + CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.