San Miguel Clinic Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SAN MIGUEL CLINIC CORP

Practice address

108 Legion Dr Ste a
Las Vegas, NM 87701-4898

Phone

(505) 454-9499

NPI assigned

May 27, 2005

Last updated

Sep 28, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shelly Mae Scoggin

Title

Director of Revenue Cycle

Phone

(505) 426-3500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 66

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.

• Laura A Allen, MD

  • Addiction Medicine (Internal Medicine) Physician
  • Albuquerque, NM
  • NPI 1144314519
  Medicare reassignment NPD
• Patrick A Craddock, MD

  • Emergency Medicine Physician
  • Albuquerque, NM
  • NPI 1477518710
  Medicare reassignment NPD
• Mehul Daulat, D.O.

  • Internal Medicine Physician
  • Santa Fe, NM
  • NPI 1508270745
  Medicare reassignment NPD
• Robin Marie Edward, MD

  • Pediatrics Physician
  • Santa Fe, NM
  • NPI 1538193818
  Medicare reassignment NPD
• Ayodele Olumide Erinle, M.D.

  • Emergency Medicine Physician
  • Gallup, NM
  • NPI 1235183492
  Medicare reassignment NPD
• James O Gonzales, MD

  • Family Medicine Physician
  • Albuquerque, NM
  • NPI 1730507955
  Medicare reassignment NPD
• Michael E. Gurule, MD

  • Cardiovascular Disease Physician
  • Belen, NM
  • NPI 1447398623
  Medicare reassignment NPD
• Allan Tilden Herman, MD

  • Emergency Medicine Physician
  • Las Vegas, NM
  • NPI 1326604851

  Family Medicine

  Medicare reassignment NPD
• Loutsios K. Ierides, MD

  • Cardiovascular Disease Physician
  • Belen, NM
  • NPI 1578601753
  Medicare reassignment NPD
• Anne Cecelia Kessler, M.D.

  • Pediatrics Physician
  • Santa Fe, NM
  • NPI 1801855309
  Medicare reassignment NPD
• Franklin Miller, M.D.

  • Internal Medicine Physician
  • Las Vegas, NM
  • NPI 1659375194
  Medicare reassignment NPD
• Raymond F. Ortiz, MD

  • Internal Medicine Physician
  • Las Vegas, NM
  • NPI 1497708754
  Medicare reassignment NPD

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790553600000",
    "number": "1114920717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18428",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 LEGION DR STE A",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014898",
            "telephone_number": "505-454-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MIGUEL CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-28",
        "status": "A",
        "authorized_official_last_name": "SCOGGIN",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "505-426-3500"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47485817",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paulina Jean Salas
• Marisa Salazar-Vigil, LMSW
• Flavio F. Salazar, LISW
• Angel Salcido-Martinez
• Samaritan House, Inc.
• San Miguel Clinic Corp (LV Medical Group- Family Medicine)
• San Miguel Clinic Corp (LV Medical Group- Family Medicine)
• San Miguel Clinic Corp Dba Northern New Mexico Urology
• San Miguel Dental
• San Miguel Emergency Group LLC

• Family Medicine Physician in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• Family Medicine Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.