NPIMap

Organization Active NPI

Presbyterian Healthcare Services

Doing business as Presbyterian Medical Group

  • Internal Medicine Physician
  • Albuquerque, NM
National Provider Identifier
1104802354
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
Presbyterian Medical Group
Practice address
5901 Harper Dr NE
Albuquerque, NM 87109-3587
Phone
(505) 823-8556
Fax
(505) 823-8555
NPI assigned
Dec 20, 2005
Last updated
Aug 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

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

Authorized official

Name
Mr. Clay Holderman
Title
Coo/CDS
Phone
(505) 724-7283

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Neurological Surgery Physician 207T00000X NU
Obstetrics & Gynecology Physician 207V00000X NU
Clinical Pathology/Laboratory Medicine Physician 207ZP0105X NU
Pediatrics Physician 208000000X NU
Neurology Physician 2084N0400X NU
Radiation Oncology Physician 2085R0001X NU
Surgery Physician 208600000X NU
Pain Medicine Physician 208VP0000X NU
Podiatrist 213E00000X NU
Urgent Care Clinic/Center 261QU0200X NU
Clinical Medical Laboratory 291U00000X NM

Addresses

Primary practice location

5901 Harper Dr NE
Albuquerque, NM 87109-3587

Mailing address

PO Box 26666
Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5356

Other names 1

  • Presbyterian Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000603 NM Part B Supplier - Clinic/Group Practice 9234041708 Receives reassigned benefits from 2,628 practitioners
13 other NPIs on this enrollment

Other NPIs on the same Medicare enrollment 11

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

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
32D0913830Presbyterian Medical Group Northside5901 Harper Drive NE, Albuquerque, NM 87109Provider-performed microscopyDec 31, 2026

National Provider Directory

National Provider Directory

Locations

1001 Silver Ave SE
Ste 200
Albuquerque, NM 87106
Phone (505) 224-7000

1325 Wyoming Blvd NE
Albuquerque, NM 87112
Phone (505) 291-5300

201 Cedar St SE
Ste 5630
Albuquerque, NM 87106
Phone (505) 563-6399

201 Cedar St SE
Ste 5660
Albuquerque, NM 87106
Phone (505) 563-6565

2100 Louisiana Blvd NE
Ste 456
Albuquerque, NM 87110
Phone (505) 559-1949

401 San Mateo Blvd SE
Albuquerque, NM 87108
Phone (505) 462-7333

4515 Coors Blvd NW
Albuquerque, NM 87120
Phone (505) 596-2200

6100 Pan American East Fwy NE
Ste 360
Albuquerque, NM 87109
Phone (505) 823-8686

7400 Menaul Blvd NE
Albuquerque, NM 87110
Phone (505) 596-2400

7920 Carmel Ave NE
Albuquerque, NM 87122
Phone (505) 828-4789

8120 Constitution Pl NE
Albuquerque, NM 87110
Phone (505) 291-2760

609 Christopher Dr
Belen, NM 87002
Phone (505) 861-1771

2400 Unser Blvd SE
Ste 18200
Rio Rancho, NM 87124
Phone (505) 253-6200

2400 Unser Blvd SE
Ste 19100
Rio Rancho, NM 87124
Phone (505) 224-7000

2400 Unser Blvd SE
Ste 19200
Rio Rancho, NM 87124
Phone (505) 291-2770

2400 Unser Blvd SE
Ste 29100
Rio Rancho, NM 87124
Phone (505) 559-6220

121 El Paso Rd
Ruidoso, NM 88345
Phone (505) 257-4061

4801 Beckner Rd
Santa Fe, NM 87507
Phone (505) 772-1234

Ownership & related parties

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
Presbyterian Espanola HospitalEspanola, NM, CCN 320011 Hospital Operational/Managerial Control May 24, 1948
Plains Regional Medical Center ClovisClovis, NM, CCN 320022 Hospital Operational/Managerial Control Jan 1, 1978
Socorro General HospitalSocorro, NM, CCN 32Z301 Hospital Operational/Managerial Control Mar 30, 2000
Socorro General HospitalSocorro, NM, CCN 321301 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 321302 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 32Z302 Hospital Operational/Managerial Control Mar 15, 2000
Socorro General Hospital Home HealthcareSocorro, NM, CCN 327027 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 1, 2000
Jan 19, 2009
Plains Regional Medical Center Clovis Home HealthcareClovis, NM, CCN 327305 Home health agency 5% Or Greater Direct Ownership Interest Feb 14, 1979
Tucumcari HospiceTucumcari, NM, CCN 321566 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 1, 2009
Dec 1, 2009

Practitioners & affiliated clinicians

Practitioners 2,728

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 2,728

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346284800000",
    "number": "1104802354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-5356",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 HARPER DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093587",
            "telephone_number": "505-823-8556",
            "fax_number": "505-823-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-20",
        "last_updated": "2012-08-30",
        "status": "A",
        "authorized_official_last_name": "HOLDERMAN",
        "authorized_official_first_name": "CLAY",
        "authorized_official_title_or_position": "COO/CDS",
        "authorized_official_telephone_number": "505-724-7283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NM",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Presbyterian Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.