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Organization Active NPI

San Juan Regional Medical Center Inc

Doing business as San Juan Regional Midwifery & Womens Health Center

  • Obstetrics & Gynecology Physician
  • Farmington, NM
National Provider Identifier
1124262415
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SAN JUAN REGIONAL MEDICAL CENTER INC
Doing business as
San Juan Regional Midwifery & Womens Health Center
SJHP OB & GYN 610
SJHP OB & GYN 634
Practice address
655 W Pinon St
Farmington, NM 87401-5973
Phone
(505) 609-2590
Fax
(505) 609-2595
NPI assigned
Apr 30, 2009
Last updated
Jul 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN JUAN REGIONAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Authorized official

Name
Kim Byrd
Title
Administrative Director of Reimburs
Phone
(505) 609-2258

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X Primary
Obstetrics & Gynecology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LX0001X

Addresses

Primary practice location

655 W Pinon St
Farmington, NM 87401-5973

Mailing address

PO Box 844088
Dallas, TX 75284-4088
Phone (505) 609-2258

Other practice location 1

634 W Pinon St
Farmington, NM 87401-5915
Phone (505) 325-4898

Other practice location 2

610 W Pinon St
Farmington, NM 87401-5974
Phone (505) 325-1123

Other names 3

  • SAN JUAN REGIONAL MIDWIFERY & WOMENS HEALTH CENTER Doing business as
  • SJHP OB & GYN 610 Doing business as
  • SJHP OB & GYN 634 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000865 NM Part B Supplier - Clinic/Group Practice 4587559505 Receives reassigned benefits from 396 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farmington, NM; Bloomfield, NM; Aztec, NM

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Immediate Care Center13 organizations share this tax ID, including this one
Part of
Immediate Care Center

Other organizations with this tax ID 12

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

Locations

655 W Pinon St
Farmington, NM 87401
Phone (505) 325-8543

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1124262415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844088",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844088",
            "telephone_number": "505-609-2258",
            "fax_number": "505-609-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 W PINON ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015973",
            "telephone_number": "505-609-2590",
            "fax_number": "505-609-2595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "634 W Pinon St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "NM",
            "postal_code": "874015915",
            "country_code": "US",
            "telephone_number": "505-325-4898",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "610 W Pinon St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "NM",
            "postal_code": "874015974",
            "country_code": "US",
            "telephone_number": "505-325-1123",
            "fax_number": "505-609-2259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SAN JUAN REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN JUAN REGIONAL MEDICAL CENTER INC",
        "enumeration_date": "2009-04-30",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "BYRD",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR OF REIMBURS",
        "authorized_official_telephone_number": "505-609-2258"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN JUAN REGIONAL MIDWIFERY & WOMENS HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAN JUAN REGIONAL MIDWIFERY & WOMENS HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SJHP OB & GYN 610",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SJHP OB & GYN 634",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.