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Pueblo Pintado Clinic

Organization Active NPI Clinic/Center · Cuba, NM

NPI 1023051133 · NPPES record last updated Oct 18, 2012

Key facts

NPI
1023051133
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
Legal business name
PUEBLO PINTADO CLINIC
Practice address
#10 Pueblo Pintado School
Cuba, NM 87013
Phone
(505) 655-3501
Fax
(505) 862-8909
NPI assigned
Jun 14, 2006
Organization subpart
Yes
Parent organization (as reported)
DHHS PHS NAIHS CROWNPOINT HOSPITAL

Authorized official

Name
Mr. Anslem Roanhorse
Title
Ceo
Phone
(505) 786-5291

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 2

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

Practitioners 269

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 269

Affiliated clinicians 46

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 46

Medicare Care Compare: Hospital

Listed as
Crownpoint Healthcare Facility CCN 320062
Type
Acute Care Hospitals
Ownership
Government - Federal
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TX, NM

Hospital certification: CCN 320062

Legal name
DHHS PHS NAIHS CROWNPOINT HOSPITAL
Doing business as
CROWNPOINT HEALTHCARE FACILITY
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 21, 1977
Last certification
Sep 22, 2023
Beds
20
Ownership / control type
Federal
Organization structure
Other · Proprietary
Incorporated
Dec 21, 1992 in NM
Enrollment address
Junction of Hwy 371 Navajo RT 9
Crownpoint, NM 87313-0358
Main/Primary Hospital Location
Hospital subgroups
Acute care

All disclosed owners & managing parties 3

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

NameRoleSinceShare
DHHS PHS Naihs Crownpoint Hospital
Organization · Crownpoint, NM 		Operational/Managerial Control Jul 1, 1976
Daryl Dineyazhe-Toya
Individual 		Corporate Officer Jul 15, 2022
Corporate Director Jul 15, 2022
Orlando Johnson
Individual 		Corporate Director Jan 30, 2023
W-2 Managing Employee Jan 30, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031230000393 TX Part B Supplier - Clinic/Group Practice 0143128041 Receives reassigned benefits from 267 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Crownpoint, NM; Cuba, NM; Thoreau, NM
O20120112000511 NM Part a Provider - Hospital 0143128041 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Crownpoint, NM; Cuba, NM; Thoreau, NM

National Provider Directory

Part of
Thoreau Clinic

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Yes

Addresses

Primary practice location

#10 Pueblo Pintado School
Cuba, NM 87013

Mailing address

PO Box 358
Crownpoint, NM 87313-0358
Phone (505) 655-6501

Other identifiers

IdentifierTypeStateIssuer
HSZ144OtherNMMEDICARE GROUP PTAN
R2915MedicaidNM

Other providers in Cuba, NM

All providers in Cuba, NM · Clinic/Center in New Mexico

Sources for this page

Verify at the official NPI Registry.