NPIMap

Organization Active NPI

La Clinica de Familia, Incorporated

Doing business as LCDF Desert Pride School Base

  • Federally Qualified Health Center (FQHC)
  • Anthony, NM
National Provider Identifier
1114578671
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DE FAMILIA, INCORPORATED
Doing business as
LCDF Desert Pride School Base
Practice address
100 Shrode Rd
Anthony, NM 88021-7350
Phone
(575) 526-1105
Fax
(575) 524-4266
NPI assigned
Sep 26, 2019
Last updated
May 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Authorized official

Name
Virgil Medina
Title
Ceo
Phone
(575) 526-1105

Specialties & licenses 1

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

Addresses

Primary practice location

100 Shrode Rd
Anthony, NM 88021-7350

Mailing address

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

Other names 1

  • LCDF Desert Pride School Base Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM2 enrollments

Enrollment records 2

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
O20191031000714 NM Part A Provider - Federally Qualified Health Center (FQHC) 6305745191 Practice locations: Anthony, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114578671. Details of each certification follow.

Federally qualified health center certification: CCN 321968

Legal name
LA CLINICA DE FAMILIA INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 30, 2019
Last certification
Oct 30, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1978 in NM
Enrollment address
100 Shrode Rd
Anthony, NM 88021-7350

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
La Clinica de Familia Incorporated48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Locations

100 Shrode Rd
Anthony, NM 88021
Phone (575) 674-2852

Ownership & related parties

All disclosed owners & managing parties 2

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 OfficerCeo Oct 22, 2019
W-2 Managing EmployeeCeo Oct 22, 2019
La Clinica de Familia Incorporated Organization, Las Cruces, NM Corporation, Non-profit Operational/Managerial Control Oct 22, 2019

Owners & managing parties with NPI records 19

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

View all 19

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
LCDF Gadsden School BaseAnthony, NM, CCN 321951 Federally qualified health center Operational/Managerial Control Aug 1, 2016
La Clinica de Familia IncorporatedChaparral, NM, CCN 321954 Federally qualified health center Operational/Managerial Control Jul 1, 2016
Picacho Middle School - School Base Health CenterLas Cruces, NM, CCN 321002 Federally qualified health center Operational/Managerial Control Jul 12, 2023
Mayfield High School - School Based Health CenterLas Cruces, NM, CCN 321014 Federally qualified health center Operational/Managerial Control Sep 1, 2025
Organ Mountain High School - School Based Health CenterLas Cruces, NM, CCN 321015 Federally qualified health center Operational/Managerial Control Sep 1, 2025

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 5

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": "1569456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620864000000",
    "number": "1114578671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 CALLE DE ALEGRA STE A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053423",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SHRODE RD",
            "city": "ANTHONY",
            "state": "NM",
            "postal_code": "880217350",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE FAMILIA, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-26",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-526-1105"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LCDF Desert Pride School Base",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LCDF Desert Pride School Base",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anthony, NM

Sources for this page

Verify at the official NPI Registry.