NPIMap

Organization Active NPI

El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Taos, NM
National Provider Identifier
1134497431
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
3516 Issued in NM
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
134 Cervantes St
Taos, NM 87571-6163
Phone
(575) 751-8032
Fax
(505) 753-7218
NPI assigned
Dec 1, 2011
Last updated
Mar 29, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
EL CENTRO FAMILY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Authorized official

Name
Mrs. Lore Pease
Title
Ceo
Phone
(505) 753-7218

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 3516 NM Primary

Addresses

Primary practice location

134 Cervantes St
Taos, NM 87571-6163

Mailing address

538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218

Other names 1

  • El Centro Family Health Taos HS SBHC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140912000784 NM Part A Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Taos, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134497431. Details of each certification follow.

Federally qualified health center certification: CCN 321932

Legal name
EL CENTRO FAMILY HEALTH
Doing business as
EL CENTRO FAMILY HEALTH TAOS HIGH SCHOOL BASED CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 10, 2014
Last certification
Sep 10, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1972 in NM
Enrollment address
134 Cervantes Road
Taos, NM 87571-6163

Other NPIs with the same Medicare PAC ID 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
El Centro Family Health10 organizations share this tax ID, including this one
Part of
El Centro Family Health

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Paul a Guiles Individual Corporate DirectorBoard Member Aug 1, 2008
Sylvia a Vigil Individual Corporate DirectorBoard Member Jan 1, 2013
Evaristo Maestas Individual Corporate DirectorBoard Member Mar 1, 2009
Nesha Morse Individual Corporate DirectorBoard Member Dec 1, 2013
Rosalie Lopez Individual Corporate DirectorBoard Member May 28, 2014
Lebeo Martinez Individual Corporate DirectorBoard Member Nov 1, 1994
Darren Deyapp Individual Corporate DirectorCeo Dec 1, 2023
Richard C Frey Individual Corporate DirectorBoard Member Oct 1, 2008
Gary Reece Individual Corporate DirectorBoard Member Mar 26, 2014
Pearl Maestas Individual Corporate DirectorBoard Member Nov 1, 2011
Francine Kain Individual Corporate OfficerCfo Oct 10, 2011
Lynsey Wheeler Individual Corporate DirectorBoard Member Aug 1, 2012
Jerome Williams Individual Corporate DirectorCoo Dec 15, 2015
Operational/Managerial ControlCoo Dec 15, 2015
Sinforosa Lovato Individual Corporate DirectorBoard Member Feb 1, 1985
Jackie Feeler Individual Corporate DirectorBoard Member Feb 1, 2013
Janette Archuleta Individual Corporate DirectorBoard Member Mar 1, 2012

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Robertson High School Based ClinicLas Vegas, NM, CCN 321952 Federally qualified health center Operational/Managerial Control Sep 7, 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 1

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": "1322697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1134497431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N PASEO DE ONATE",
            "address_2": "P.O. BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322618",
            "telephone_number": "505-753-7218",
            "fax_number": "505-753-5581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 CERVANTES ST",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716163",
            "telephone_number": "575-751-8032",
            "fax_number": "505-753-7218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EL CENTRO FAMILY HEALTH",
        "enumeration_date": "2011-12-01",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "PEASE",
        "authorized_official_first_name": "LORE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-753-7218",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "3516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Family Health Taos HS SBHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Taos, NM

Sources for this page

Verify at the official NPI Registry.