NPIMap

Organization Active NPI

El Pueblo Health Services, Inc

Doing business as El Pueblo Family Healthcare

  • Family Nurse Practitioner
  • Bernalillo, NM
National Provider Identifier
1144302415
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R34317 Issued in NM
Legal business name
EL PUEBLO HEALTH SERVICES, INC
Doing business as
El Pueblo Family Healthcare
Practice address
121 Calle del Presidente
Bernalillo, NM 87004-6091
Phone
(505) 867-2324
Fax
(505) 867-3511
NPI assigned
Oct 19, 2006
Last updated
Apr 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Authorized official

Name
Mr. Geoffrey D Steffens, CNP
Title
Ceo/CNP
Phone
(505) 867-2324

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Family Nurse Practitioner 363LF0000X R34317 NM Primary
Family Medicine Physician 207Q00000X 92-263 NM

Addresses

Primary practice location

121 Calle del Presidente
Bernalillo, NM 87004-6091

Mailing address

121 Calle del Presidente
Bernalillo, NM 87004-6091
Phone (505) 867-2324

Other identifiers 1

IdentifierTypeStateIssuer
47902MedicaidNM

Other names 1

  • EL PUEBLO FAMILY HEALTHCARE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040519001418 NM Part B Supplier - Clinic/Group Practice 9739170697 Receives reassigned benefits from 17 practitioners
Practice locations: Bernalillo, NM
O20110309000908 NM Part A Provider - Federally Qualified Health Center (FQHC) 9739170697 Practice locations: Bernalillo, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144302415. Details of each certification follow.

Federally qualified health center certification: CCN 321842

Legal name
EL PUEBLO HEALTH SERVICES, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1993
Last certification
Jan 1, 1993
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 1976 in NM
Enrollment address
121 Calle del Presidente
Bernalillo, NM 87004-6091

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D0058000El Pueblo Health Services Inc121 Calle del Presidente, Bernalillo, NM 87004Provider-performed microscopyJan 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
El Pueblo Family Healthcare3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/30308/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Alan Firestone Individual Corporate DirectorBoard Member Oct 1, 2013
George Hiddy Individual Corporate DirectorBoard Member Jul 1, 2006
Pamela a Bosma Individual Corporate DirectorBoard Member Jul 1, 2013
Ramona Salazar Individual Corporate DirectorBoard Member Jul 1, 2014
Richard V Adesso Individual W-2 Managing EmployeeExecutive Director Jan 8, 2016 100%

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1144302415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CALLE DEL PRESIDENTE",
            "city": "BERNALILLO",
            "state": "NM",
            "postal_code": "870046091",
            "telephone_number": "505-867-2324",
            "fax_number": "505-867-3511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CALLE DEL PRESIDENTE",
            "city": "BERNALILLO",
            "state": "NM",
            "postal_code": "870046091",
            "telephone_number": "505-867-2324",
            "fax_number": "505-867-3511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL PUEBLO HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "STEFFENS",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO/CNP",
        "authorized_official_telephone_number": "505-867-2324",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "R34317",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "92-263",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47902",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EL PUEBLO FAMILY HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EL PUEBLO FAMILY HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bernalillo, NM

Sources for this page

Verify at the official NPI Registry.