El Centro Family Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

3516 Issued in NM

Legal business name

EL CENTRO FAMILY HEALTH

Practice address

235 Paseo del Canon E
Taos, NM 87571-6239

Phone

(575) 751-8032

Fax

(575) 758-7088

NPI assigned

Nov 30, 2011

Last updated

Nov 21, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lore Pease

Title

Ceo

Phone

(505) 753-7218

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• El Centro Family Health Taos MS SBHC Other name

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003183393. Details of each certification follow.

• CCN 321931 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 321931

Legal name

EL CENTRO FAMILY HEALTH

Doing business as

EL CENTRO FAMILY HEALTH TAOS MIDDLE SCHOOL SBHC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 10, 2014

Last certification

Sep 10, 2014

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 1, 1972 in NM

Enrollment address

235 Paseo del Canon E
Taos, NM 87571-6239

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Espanola, NM
  • NPI 1780689034

  O20140912000420

  Same enrollment

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GIBDBA

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chloe Marie Abreu, FNP-C

  • Family Nurse Practitioner
  • Taos, NM
  • NPI 1184382384
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416528000000",
    "number": "1003183393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N PASEO DE ONATE",
            "address_2": "P.O. BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322618",
            "telephone_number": "505-753-7218",
            "fax_number": "505-753-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 PASEO DEL CANON E",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716239",
            "telephone_number": "575-751-8032",
            "fax_number": "575-758-7088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2014-11-21",
        "status": "A",
        "authorized_official_last_name": "PEASE",
        "authorized_official_first_name": "LORE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-753-7218",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "3516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1780689034",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52285774",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Family Health Taos MS SBHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• David Edward Dyess, CRNA
• Theresa Maria Dyess, RN
• Paula R Eberhardt, LADAC
• Eight Northern Indian Pueblos Council, Inc. (Butterfly Healing Center)
• Eight Northern Indian Pueblos Council, Inc.
• El Centro Family Health
• El Centro Family Health
• Meredith Benton Eley
• Robert Mills Elliott, DDS
• Travis Ely

• Federally Qualified Health Center (FQHC) in Taos, NM
• Providers in Taos, NM by specialty
• Federally Qualified Health Center (FQHC) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.