NPIMap

La Clinica de Familia, Incorporated

Organization Active NPI Federally Qualified Health Center (FQHC) · Santa Teresa, NM

NPI 1083687115 · NPPES record last updated May 13, 2021

Key facts

NPI
1083687115
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
LA CLINICA DE FAMILIA, INCORPORATED
Practice address
100 Airport Rd
Santa Teresa, NM 88008-9703
Phone
(575) 874-9338
Fax
(575) 874-9338
NPI assigned
Feb 9, 2006
Organization subpart
No

Authorized official

Name
Virgil Medina
Title
Chief Executive Officer
Phone
(575) 526-1105

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 16

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

Other NPIs with the same Medicare PAC ID 19

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

Corporate family (same tax ID) 47

Organizations that report the same tax identification number in the National Provider Directory.

View all 47

Practitioners 70

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

View all 70

Medicare participation

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

Federally qualified health center certification: CCN 321946

Legal name
LA CLINICA DE FAMILIA INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 11, 2016
Last certification
Jul 11, 2016
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Oct 12, 1978 in NM
Enrollment address
100 Airport Rd
Santa Teresa, NM 88008-9703

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Virgil Medina
Individual 		Corporate Officer
Interim Ceo		 Apr 28, 2017
W-2 Managing Employee
Interim Ceo		 Apr 28, 2017

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
LCDF Gadsden School Base
Anthony, NM · CCN 321951		 Federally qualified health center Operational/Managerial Control Aug 1, 2016
La Clinica de Familia Incorporated
Chaparral, NM · CCN 321954		 Federally qualified health center Operational/Managerial Control Jul 1, 2016
La Clinica de Familia Incorporated
Anthony, NM · CCN 321968		 Federally qualified health center Operational/Managerial Control Oct 22, 2019
Picacho Middle School - School Base Health Center
Las Cruces, NM · CCN 321002		 Federally qualified health center Operational/Managerial Control Jul 12, 2023
Mayfield High School - School Based Health Center
Las Cruces, NM · CCN 321014		 Federally qualified health center Operational/Managerial Control Sep 1, 2025
Organ Mountain High School - School Based Health Center
Las Cruces, NM · CCN 321015		 Federally qualified health center Operational/Managerial Control Sep 1, 2025

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031231000076 NM Part B Supplier - Clinic/Group Practice 6305745191 Receives reassigned benefits from 141 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sunland Park, NM; Santa Teresa, NM; Mesilla, NM; Las Cruces, NM; Anthony, NM; Chaparral, NM; La Mesa, NM
O20160707000104 NM Part a Provider - Federally Qualified Health Center (FQHC) 6305745191 Practice locations: Santa Teresa, NM

National Provider Directory

Tax ID family
La Clinica de Familia (48 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NM Yes

Addresses

Primary practice location

100 Airport Rd
Santa Teresa, NM 88008-9703

Mailing address

385 Calle de Alegra
BLDG. a
Las Cruces, NM 88005-3423
Phone (575) 526-1105

Other identifiers

IdentifierTypeStateIssuer
94479712MedicaidNM
321946OtherNMMEDICARE

Other names

  • La clinica De Familia Santa Teresa School Base Doing business as

Other providers in Santa Teresa, NM

All providers in Santa Teresa, NM · Federally Qualified Health Center (FQHC) in New Mexico

Sources for this page

Verify at the official NPI Registry.