NPIMap

Organization Active NPI

Clinica Campesina Family Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Broomfield, CO
National Provider Identifier
1124866801
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Practice address
897 US Hwy 287
Suite 200
Broomfield, CO 80020
Phone
(303) 443-8500
Fax
(720) 687-2752
NPI assigned
Jul 17, 2024
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Brian J Johnston
Title
Cfo
Phone
(303) 926-0625

Other NPIs on the same Medicare enrollment 15

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

View all 15

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000276 CO Part B Supplier - Clinic/Group Practice 7315850484 Receives reassigned benefits from 246 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Broomfield, CO; Longmont, CO; Lafayette, CO; Boulder, CO

National Provider Directory

National Provider Directory
Tax ID family
Clinica Campesina Fmly HLTH27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

NPPES NPI Registry

Primary practice location

897 US Hwy 287
Suite 200
Broomfield, CO 80020

Mailing address

1455 Dixon Ave
Lafayette, CO 80026-8879
Phone (303) 443-8500

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
82830061MedicaidCO

Other names 3

NPPES NPI Registry
  • Clinica Family Health and Wellness Doing business as
  • Mental Health Partners Doing business as
  • Mental Health Center of Boulder County, Inc. Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 17, 2024.

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1124866801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 DIXON AVE",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800268879",
            "telephone_number": "303-443-8500",
            "fax_number": "720-687-2752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "897 US HWY 287",
            "address_2": "SUITE 200",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "80020",
            "telephone_number": "303-443-8500",
            "fax_number": "720-687-2752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA CAMPESINA FAMILY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-926-0625"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82830061",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinica Family Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mental Health Partners",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mental Health Center of Boulder County, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.