NPIMap

Organization Active NPI

San Juan Regional Medical Center Inc

Doing business as San Juan Pediatrics

  • Pediatrics Physician
  • Farmington, NM
National Provider Identifier
1093800534
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SAN JUAN REGIONAL MEDICAL CENTER INC
Doing business as
San Juan Pediatrics
Practice address
407 S Schwartz Ave
Suite 102
Farmington, NM 87401-5925
Phone
(505) 609-6700
Fax
(505) 609-6701
NPI assigned
Oct 3, 2006
Last updated
Jul 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN JUAN REGIONAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

407 S Schwartz Ave
Suite 102
Farmington, NM 87401-5925

Mailing address

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

Other names 1

  • SAN JUAN PEDIATRICS Doing business as

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
32D0950152San Juan Health Partners Pediatrics407 S Schwartz Ave, Suite 102, Farmington, NM 87401Certificate of waiverAug 18, 2026

National Provider Directory

National Provider Directory
Tax ID family
San Juan Region Med Ctr Inc13 organizations share this tax ID, including this one
Part of
San Juan Region Med Ctr Inc

Other organizations with this tax ID 12

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

Locations

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

100 N Church St
Ste C
Bloomfield, NM 87413
Phone (505) 609-6675

622 W Maple St
Farmington, NM 87401

630 W Maple St
Farmington, NM 87401
Phone (505) 325-1123

Practitioners & affiliated clinicians

Practitioners 147

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 147

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1093800534",
    "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 102",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015925",
            "telephone_number": "505-609-6700",
            "fax_number": "505-609-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN JUAN REGIONAL MEDICAL CENTER INC",
        "enumeration_date": "2006-10-03",
        "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": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN JUAN PEDIATRICS",
            "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 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.