| Oak Street Health Physicians Group Of New Mexico Llc | |
|
4208 Central Ave Sw Ste G Albuquerque NM 87105-1695 | |
| (312) 733-9730 | |
| Not Available |
| Full Name | Oak Street Health Physicians Group Of New Mexico Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4208 Central Ave Sw Ste G, Albuquerque, New Mexico |
| Authorized Official Name and Position | Griffin Myers (CMO, FOUNDER) |
| Authorized Official Contact | 3072642085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oak Street Health Physicians Group Of New Mexico Llc Po Box 740018 Atlanta GA 30374-0018 Ph: (312) 733-9730 | Oak Street Health Physicians Group Of New Mexico Llc 4208 Central Ave Sw Ste G Albuquerque NM 87105-1695 Ph: (312) 733-9730 |
| NPI Number | 1134793151 |
|---|---|
| Provider Enumeration Date | 05/14/2021 |
| Last Update Date | 06/30/2023 |
| Certification Date | 06/30/2023 |
| Medicare PECOS PAC ID | 4981001096 |
|---|---|
| Medicare Enrollment ID | O20210916000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134793151 | NPI | - | NPPES |
| Provider Name | Frances K Lopez-bushnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508847567 PECOS PAC ID: 1456318328 Enrollment ID: I20041213000273 |
| Provider Name | Michael Chartrand |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851317192 PECOS PAC ID: 2163501677 Enrollment ID: I20090904000475 |
| Provider Name | Claudia Alfaro-andrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932315975 PECOS PAC ID: 1951447457 Enrollment ID: I20091014000589 |
| Provider Name | Anita M Velasco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932430501 PECOS PAC ID: 8921139452 Enrollment ID: I20100628000780 |
| Provider Name | Will Kaufman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083820120 PECOS PAC ID: 0244386712 Enrollment ID: I20130222000249 |
| Provider Name | Thomas Longley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245597970 PECOS PAC ID: 8921251091 Enrollment ID: I20150601001878 |
| Provider Name | Scott T Bernhardt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710210760 PECOS PAC ID: 9931481660 Enrollment ID: I20170112002568 |
| Provider Name | Baudilio J Velez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023105632 PECOS PAC ID: 5890853600 Enrollment ID: I20170407001634 |
| Provider Name | Cassandra M Otero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487118824 PECOS PAC ID: 6204176886 Enrollment ID: I20190318002036 |
| Provider Name | Barbara Sue Gross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881246247 PECOS PAC ID: 9638407745 Enrollment ID: I20190828001438 |
| Provider Name | Leyna Inberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801255898 PECOS PAC ID: 9830498138 Enrollment ID: I20210119001771 |
| Provider Name | Samuel Tri |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1083935076 PECOS PAC ID: 5496054272 Enrollment ID: I20210119002088 |
| Provider Name | Griffin Myers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1871817643 PECOS PAC ID: 7719145127 Enrollment ID: I20210916000589 |
| Provider Name | Mahmoud Ismail |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326415365 PECOS PAC ID: 2769880640 Enrollment ID: I20211006003242 |
| Provider Name | Stephen Sproul |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427030451 PECOS PAC ID: 5991786386 Enrollment ID: I20220312000238 |
| Provider Name | Cindy Callisto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649524612 PECOS PAC ID: 5496018202 Enrollment ID: I20221110001284 |
| Provider Name | Shalada Cristal Creecy-gutierrez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336653906 PECOS PAC ID: 2860860673 Enrollment ID: I20221129002833 |
| Provider Name | Natalia Klusacek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497142285 PECOS PAC ID: 1759686660 Enrollment ID: I20221229001776 |
| Provider Name | Jamie Tom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497290720 PECOS PAC ID: 3274806054 Enrollment ID: I20230511000765 |
| Provider Name | Alyssa Marie Swisher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164206579 PECOS PAC ID: 4183079494 Enrollment ID: I20231005003514 |
| Provider Name | Karen Elaine Cardon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184866402 PECOS PAC ID: 0446549455 Enrollment ID: I20231221004145 |
| Provider Name | Stacy Ali |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255415451 PECOS PAC ID: 8921041542 Enrollment ID: I20240116003540 |
| Provider Name | Rebecca Murray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134557473 PECOS PAC ID: 2365675451 Enrollment ID: I20240314001588 |
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