NPIMap

Organization Active NPI

Clinica Campesina Family Health Services

Doing business as Clinica Family Health

  • Federally Qualified Health Center (FQHC)
  • Nederland, CO
National Provider Identifier
1104579481
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Doing business as
Clinica Family Health
Practice address
80 Big Springs Dr Ste 102
Nederland, CO 80466-8900
Phone
(303) 650-4460
NPI assigned
Jan 27, 2022
Last updated
Jan 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CLINICA CAMPESINA FAMILY HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Authorized official

Name
Brian J Johnston
Title
Cfo
Phone
(303) 926-0625

Specialties & licenses 1

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

Addresses

Primary practice location

80 Big Springs Dr Ste 102
Nederland, CO 80466-8900

Mailing address

1735 S Public Rd
Lafayette, CO 80026-7093
Phone (303) 926-0625

Other names 1

  • Clinica Family Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220711003677 CO Part A Provider - Federally Qualified Health Center (FQHC) 7315850484 Practice locations: Nederland, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104579481. Details of each certification follow.

Federally qualified health center certification: CCN 061033

Legal name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Doing business as
CLINICA FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 13, 2022
Last certification
Jul 13, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 2022 in CO
Enrollment address
80 Big Springs Dr
Ste 102
Nederland, CO 80466-8900

Other NPIs with the same Medicare PAC ID 8

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

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
06D2264310Clinica Family Health - Nederland80 Big Springs Dr, Suite 102, Nederland, CO 80466Provider-performed microscopyJul 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
Clinica Campesina Fmly HLTH27 organizations share this tax ID, including this one
Part of
Clinica Campesina Fmly HLTH

Other organizations with this tax ID 26

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

View all 26

Locations

80 Big Springs Dr
Ste 102
Nederland, CO 80466

Ownership & related parties

All disclosed owners & managing parties 15

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 OfficerBoard Member Oct 1, 2009
Jeff Zayach Individual Corporate OfficerBoard Member Aug 1, 2021
Carolina Flores Manross Individual Corporate OfficerBoard Member Aug 1, 2020
Douglas Jones Individual Corporate OfficerBoard Member Sep 1, 2011
Ella Padilla Individual Corporate OfficerBoard Member Sep 1, 2018
Matthew Antush Individual Corporate OfficerBoard Member Jul 1, 2019
Heather Elkins Individual Corporate OfficerBoard Member Apr 1, 2017
Brian Johnston Individual Corporate OfficerCfo Nov 29, 2022
Corporate DirectorCfo Nov 29, 2022
W-2 Managing EmployeeCfo Nov 29, 2022
Cherlyn a Marriott Individual Corporate OfficerBoard Member Sep 1, 2011
Lizandro Gonzalez Individual Corporate OfficerBoard Member Aug 1, 2020
Clinica Campesina Family Health Services Organization, Nederland, CO Non-profit Other Jun 1, 2022
Edson Hernandez Individual Corporate OfficerBoard Member Oct 1, 2017
Mayra Martinez Individual Corporate OfficerBoard Member Aug 1, 2016
Heidy Ordonez Individual Corporate OfficerBoard Member Sep 1, 2017
Simon G Smith Individual Corporate OfficerCeo Jan 10, 2011
Corporate DirectorCeo Jan 10, 2011
W-2 Managing EmployeeCeo Jan 10, 2011

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

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

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1643241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643241600000",
    "number": "1104579481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093",
            "telephone_number": "303-926-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 BIG SPRINGS DR STE 102",
            "city": "NEDERLAND",
            "state": "CO",
            "postal_code": "804668900",
            "telephone_number": "303-650-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA CAMPESINA FAMILY HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLINICA CAMPESINA FAMILY HEALTH SERVICES",
        "enumeration_date": "2022-01-27",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-926-0625"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinica Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nederland, CO

Sources for this page

Verify at the official NPI Registry.