NPIMap

Organization Active NPI

La Clinica del Pueblo, Inc.

  • Federally Qualified Health Center (FQHC)
  • Washington, DC
National Provider Identifier
1124227590
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DEL PUEBLO, INC.
Practice address
2831 15TH Street NW
Washington, DC 20009-4607
Phone
(202) 462-4788
Fax
(202) 332-0085
NPI assigned
Jul 16, 2007
Last updated
Oct 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Authorized official

Name
Micaela Acuna
Title
Patient Revenue Manager
Phone
(240) 582-8828

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Clinic/Center 261Q00000X 52194XXXX650001047 DC
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

2831 15TH Street NW
Washington, DC 20009-4607

Mailing address

2831 15TH Street NW
Washington, DC 20009-4607
Phone (202) 462-4788

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040228000337 DC Part B Supplier - Clinic/Group Practice 3971490558 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
Practice locations: Hyattsville, MD; Washington, DC
O20071126000484 DC Part A Provider - Federally Qualified Health Center (FQHC) 3971490558 Practice locations: Washington, DC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124227590. Details of each certification follow.

Federally qualified health center certification: CCN 091836

Legal name
LA CLINICA DEL PUEBLO INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2008
Last certification
Jan 15, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 11, 1995 in DC
Enrollment address
2831 15TH St NW
Washington, DC 20009-4607

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
La Clinica del Pueblo Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2831 15th St NW
#7
Washington, DC 20009
Phone (202) 462-4788

2970 Belcrest Center Dr
Hyattsville, MD 20782
Phone (240) 467-2100

2970 Belcrest Center Dr
#301
Hyattsville, MD 20782
Phone (240) 714-5247

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carlos Plazas Individual 5% Or Greater Indirect Ownership InterestCfo/Coo Jan 1, 2024
W-2 Managing EmployeeCfo/Coo Jan 1, 2024

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
La Clinica del Pueblo IncHyattsville, MD, CCN 211907 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 27, 2016

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 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728432000000",
    "number": "1124227590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2831 15TH STREET NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200094607",
            "telephone_number": "202-462-4788",
            "fax_number": "202-332-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2831 15TH STREET NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200094607",
            "telephone_number": "202-462-4788",
            "fax_number": "202-332-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DEL PUEBLO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A",
        "authorized_official_last_name": "ACUNA",
        "authorized_official_first_name": "MICAELA",
        "authorized_official_title_or_position": "PATIENT REVENUE MANAGER",
        "authorized_official_telephone_number": "240-582-8828"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "DC",
            "license": "52194XXXX650001047",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.