NPIMap

Organization Active NPI

San Juan Regional Medical Center Inc

  • Cardiovascular Disease Physician
  • Farmington, NM
National Provider Identifier
1033327770
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
SAN JUAN REGIONAL MEDICAL CENTER INC
Practice address
407 S Schwartz Ave
Suite 202
Farmington, NM 87401
Phone
(505) 609-6770
Fax
(505) 609-6775
NPI assigned
May 18, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kim Byrd
Title
Administrative Director of Reimburs
Phone
(505) 609-2258

Other NPIs on the same Medicare enrollment 19

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

View all 19

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 250

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

View all 250

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
32D1076208San Juan Regional Cardiology407 South Schwartz Suite 202, Farmington, NM 87401Certificate of waiverNov 6, 2027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040218000865 NM Part B Supplier - Clinic/Group Practice 4587559505 Receives reassigned benefits from 396 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farmington, NM; Bloomfield, NM; Aztec, NM
O20170309000357 CO Part B Supplier - Clinic/Group Practice 4587559505 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
Practice locations: Durango, CO

National Provider Directory

National Provider Directory

Locations

480 Wolverine Dr
Ste 12
Bayfield, CO 81122
Phone (970) 444-0260

407 S Schwartz Ave
Ste 102
Farmington, NM 87401
Phone (505) 609-6700

622 W Maple St
Ste B
Farmington, NM 87401
Phone (505) 327-4867

655 W Pinon St
Farmington, NM 87401
Phone (505) 325-8543

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0000X Primary
Pulmonary Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RP1001X
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X

Addresses

NPPES NPI Registry

Primary practice location

407 S Schwartz Ave
Suite 202
Farmington, NM 87401

Mailing address

PO Box 844088
Dallas, TX 75284-4088
Phone (505) 609-2258

Other practice location 1

480 Wolverine Dr Ste 12
Bayfield, CO 81122-9653
Phone (970) 444-0260

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
39608514MedicaidCO
97172766MedicaidNM

Other names 2

NPPES NPI Registry
  • SAN JUAN REGIONAL CARDIOLOGY Doing business as
  • San Juan Regional Heart Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 16, 2025.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1033327770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844088",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844088",
            "telephone_number": "505-609-2258",
            "fax_number": "505-609-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S SCHWARTZ AVE",
            "address_2": "SUITE 202",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "87401",
            "telephone_number": "505-609-6770",
            "fax_number": "505-609-6775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "480 Wolverine Dr Ste 12",
            "address_purpose": "LOCATION",
            "city": "Bayfield",
            "state": "CO",
            "postal_code": "811229653",
            "country_code": "US",
            "telephone_number": "970-444-0260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN JUAN REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "BYRD",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR OF REIMBURS",
        "authorized_official_telephone_number": "505-609-2258"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39608514",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97172766",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN JUAN REGIONAL CARDIOLOGY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Juan Regional Heart Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Juan Regional Heart Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.