NPIMap

Organization Active NPI

La Clinica de Familia, Incorporated

Doing business as Mayfield High School Base

  • Federally Qualified Health Center (FQHC)
  • Las Cruces, NM
National Provider Identifier
1134917040
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DE FAMILIA, INCORPORATED
Doing business as
Mayfield High School Base
Practice address
1955 N Valley Dr
Las Cruces, NM 88007-5154
Phone
(575) 526-1105
Fax
(575) 524-4266
NPI assigned
Apr 29, 2025
Last updated
Apr 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Authorized official

Name
Virgil Medina
Title
Ceo
Phone
(575) 526-1105

Specialties & licenses 1

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

Addresses

Primary practice location

1955 N Valley Dr
Las Cruces, NM 88007-5154

Mailing address

385 Calle de Alegra Ste a
Las Cruces, NM 88005-3423
Phone (575) 526-1105

Other names 1

  • Mayfield High School Base Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251204001187 NM Part A Provider - Federally Qualified Health Center (FQHC) 6305745191 Practice locations: Las Cruces, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134917040. Details of each certification follow.

Federally qualified health center certification: CCN 321014

Legal name
LA CLINICA DE FAMILIA INCORPORATED
Doing business as
MAYFIELD HIGH SCHOOL - SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 20, 2025
Last certification
Nov 20, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1955 N Valley Dr
RM 101
Las Cruces, NM 88007-5154

Other NPIs with the same Medicare PAC ID 19

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

View all 19

National Provider Directory

National Provider Directory
Tax ID family
La Clinica de Familia Incorporated48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Locations

826 Anthony Dr
Anthony, NM 88021
Phone (575) 201-5135

855 Anthony Dr
Anthony, NM 88021
Phone (575) 882-3607

855 N Main
Anthony, NM 88021
Phone 57552611052406

880 Anthony Dr
Ste 12
Anthony, NM 88021
Phone (575) 201-5134

880 Anthony Dr
Ste 13
Anthony, NM 88021
Phone (505) 882-7200

880 Anthony Dr
Ste 8A
Anthony, NM 88021
Phone (575) 201-5134

800 S County Line Dr
Chaparral, NM 88081
Phone (575) 525-4815

118 S Main St
Las Cruces, NM 88001
Phone (575) 527-7975

1950 S Sonoma Ranch Blvd
Las Cruces, NM 88011
Phone (575) 525-4811

1955 N Valley Dr
Rm 101
Las Cruces, NM 88007

390 Calle de Alegra
Las Cruces, NM 88005
Phone (575) 556-8150

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Virgil Medina Individual Operational/Managerial ControlCeo Sep 1, 2025
La Clinica de Familia Incorporated Organization, Las Cruces, NM Corporation, Non-profit Operational/Managerial Control Sep 1, 2025

Owners & managing parties with NPI records 19

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 19

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
LCDF Gadsden School BaseAnthony, NM, CCN 321951 Federally qualified health center Operational/Managerial Control Aug 1, 2016
La Clinica de Familia IncorporatedChaparral, NM, CCN 321954 Federally qualified health center Operational/Managerial Control Jul 1, 2016
La Clinica de Familia IncorporatedAnthony, NM, CCN 321968 Federally qualified health center Operational/Managerial Control Oct 22, 2019
Picacho Middle School - School Base Health CenterLas Cruces, NM, CCN 321002 Federally qualified health center Operational/Managerial Control Jul 12, 2023
Organ Mountain High School - School Based Health CenterLas Cruces, NM, CCN 321015 Federally qualified health center Operational/Managerial Control Sep 1, 2025

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 218

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 218

NPI Registry JSON

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

{
    "created_epoch": "1745884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1134917040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 CALLE DE ALEGRA STE A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053423",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1955 N VALLEY DR",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880075154",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE FAMILIA, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-29",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-526-1105"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mayfield High School Base",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.