NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Ojo Encino Navajo Clinic

  • Federally Qualified Health Center (FQHC)
  • Ojo Encino, NM
National Provider Identifier
1023186707
Registry record updated Jan 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
1023186707 Issued in NM
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Ojo Encino Navajo Clinic
Practice address
2 Ojo Encino Chapter Rd
Ojo Encino, NM 87013
Phone
(505) 731-2268
Fax
(505) 731-2379
NPI assigned
Dec 1, 2006
Last updated
Jan 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2021

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

Authorized official

Name
Doug Smith
Title
Executive Vice President
Phone
(505) 992-5565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 1023186707 NM Primary
Non-Pharmacy Dispensing Site 332900000X CL00007174 NM

Addresses

Primary practice location

2 Ojo Encino Chapter Rd
Ojo Encino, NM 87013

Mailing address

PO Box 2267
Santa Fe, NM 87504-2267
Phone (505) 982-5565

Other identifiers 3

IdentifierTypeStateIssuer
3209548OtherNCPDP PROVIDER IDENTIFICATION NUMBER
321824OtherNMFQHC CLINIC/CENTER
48421MedicaidNM

Other names 1

  • OJO ENCINO NAVAJO CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091110000585 NM Part A Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Ojo Encino, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023186707. Details of each certification follow.

Federally qualified health center certification: CCN 321824

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
OJO ENCINO CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
2 Ojo Encino Chapter Rd
Ojo Encino, NM 87013

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2144186PMS Ojo Encino Clinic#2 Ojo Encino Chapter Road, Cuba, NM 87013Certificate of waiverFeb 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
PMS Dba Roundtree Childrens' Development Services70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Anne Liley Individual Corporate DirectorBoard Member Feb 11, 2016
Mario Atencio Individual Corporate DirectorBoard Member Mar 12, 2019
Roberta Lee Individual Corporate DirectorBoard Member Oct 11, 2022
Steven C Hansen Individual Corporate OfficerPresident Nov 1, 2007
Mike Antiporda Individual Corporate DirectorBoard Member Jun 3, 2022
Scott Michlin Individual Corporate DirectorBoard Member Aug 22, 2011
Doug Smith Individual Corporate OfficerExecutive Vice President & Treas Aug 22, 2011
Laura Jaramillo Individual Corporate Director Nov 1, 2021
Marlene Waukazoo Individual Corporate DirectorBoard Member Nov 1, 2012
Don Daniel Individual Corporate OfficerCorporate Secretary May 2, 2014
Diane Lopez Individual Corporate OfficerVice President & Corporate Secre Aug 22, 2011
Bryan Romkey Individual Corporate DirectorBoard Member Feb 5, 2015
Hilda Keller Individual Corporate Director Jul 1, 2021
Lillie Lewis Individual Corporate DirectorBoard Member May 2, 2013
Frank McCasland Individual Corporate DirectorBoard Member Aug 22, 2011
Melissa Sharpe Individual Corporate DirectorBoard Member Feb 5, 2015
Daniel Evans Individual Corporate DirectorBoard Member Feb 1, 2017
Susan K Smith Individual Corporate DirectorBoard Member Aug 22, 2011
Cynthia Rael-Vigil Individual Corporate DirectorBoard Member Aug 22, 2011
Kent E Mosbrucker Individual W-2 Managing EmployeeVice President of Finance Aug 31, 2018

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Santa Fe Family Health CenterSante Fe, NM, CCN 321950 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 2012

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610150400000",
    "number": "1023186707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2267",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875042267",
            "telephone_number": "505-982-5565",
            "fax_number": "505-992-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 OJO ENCINO CHAPTER RD",
            "city": "OJO ENCINO",
            "state": "NM",
            "postal_code": "87013",
            "telephone_number": "505-731-2268",
            "fax_number": "505-731-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2021-01-09",
        "certification_date": "2021-01-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "505-992-5565"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "1023186707",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NM",
            "license": "CL00007174",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3209548",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC CLINIC/CENTER",
            "identifier": "321824",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48421",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OJO ENCINO NAVAJO CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OJO ENCINO NAVAJO CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ojo Encino, NM

Sources for this page

Verify at the official NPI Registry.