NPIMap

Organization Active NPI

Clinica Campesina Family Health Services

Doing business as Clinica Campesina - Thornton

  • Federally Qualified Health Center (FQHC)
  • Thornton, CO
National Provider Identifier
1093702177
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0556 Issued in CO
Legal business name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Doing business as
Clinica Campesina - Thornton
Practice address
8990 N Washington St
Thornton, CO 80229-4537
Phone
(720) 929-1655
Fax
(720) 929-1417
NPI assigned
Oct 4, 2005
Last updated
Jan 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Authorized official

Name
Simon Smith
Title
Ceo
Phone
(303) 665-3036

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0556 CO Primary

Addresses

Primary practice location

8990 N Washington St
Thornton, CO 80229-4537

Mailing address

1735 S Public Rd Ste 203
Lafayette, CO 80026-7093
Phone (303) 665-3036

Other identifiers 1

IdentifierTypeStateIssuer
17001846MedicaidCO

Other names 1

  • Clinica Campesina - Thornton Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000276 CO Part B Supplier - Clinic/Group Practice 7315850484 Receives reassigned benefits from 246 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Broomfield, CO; Longmont, CO; Lafayette, CO; Boulder, CO
O20060125000436 CO Part A Provider - Federally Qualified Health Center (FQHC) 7315850484 Practice locations: Thornton, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093702177. Details of each certification follow.

Federally qualified health center certification: CCN 061868

Legal name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 10, 2001
Last certification
Oct 10, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1977 in CO
Enrollment address
8990 Washington St
Thornton, CO 80229-4537

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Locations

8990 Washington St
Thornton, CO 80229
Phone (720) 929-1655

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Inez D Buggs Individual Corporate DirectorBoard Member Oct 1, 2009
Jeff Zayach Individual Corporate DirectorBoard Member Aug 1, 2021
Carolina Flores Manross Individual Corporate DirectorBoard Member Aug 1, 2020
Douglas Jones Individual Corporate DirectorBoard Member Sep 1, 2011
Ella Padilla Individual Corporate DirectorBoard Member Sep 1, 2018
Matthew Antush Individual Corporate DirectorBoard Member Jul 1, 2019
Heather Elkins Individual Corporate DirectorBoard Member Apr 1, 2017
Brian Johnston Individual Corporate OfficerCfo Dec 2, 2022
Corporate DirectorCfo Dec 2, 2022
Cherlyn a Marriott Individual Corporate DirectorChairman of the Board Sep 1, 2011
Lizandro Gonzalez Individual Corporate DirectorBoard Member Aug 1, 2020
Edson Hernandez Individual Corporate DirectorBoard Member Oct 1, 2017
Mayra Martinez Individual Corporate DirectorBoard Member Aug 1, 2016
Heidy Ordonez Individual Corporate DirectorBoard Member Aug 1, 2021
Simon G Smith Individual Corporate DirectorCeo Jan 10, 2011
W-2 Managing EmployeeCeo Jan 10, 2011

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Clinica Family HealthNederland, CO, CCN 061033 Federally qualified health center Other Jun 1, 2022
Clinica Family Health ServicesBlack Hawk, CO, CCN 061034 Federally qualified health center Other Jun 1, 2022

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 77

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.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1093702177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD STE 203",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093",
            "telephone_number": "303-665-3036",
            "fax_number": "303-665-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8990 N WASHINGTON ST",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802294537",
            "telephone_number": "720-929-1655",
            "fax_number": "720-929-1417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA CAMPESINA FAMILY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-665-3036"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": "0556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17001846",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinica Campesina - Thornton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinica Campesina - Thornton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thornton, CO

Sources for this page

Verify at the official NPI Registry.