NPIMap

Organization Active NPI

Presbyterian Healthcare Services

Doing business as Tucumcari Hospice

  • Community Based Hospice Care Agency
  • Tucumcari, NM
National Provider Identifier
1184952368
Registry record updated May 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
1T3328 Issued in NM
Legal business name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
Tucumcari Hospice
Practice address
301 E Miel de Luna Ave
Tucumcari, NM 88401-3810
Phone
(575) 461-7240
Fax
(575) 461-7245
NPI assigned
Nov 25, 2009
Last updated
May 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2011

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

Authorized official

Name
Robert Garcia
Title
VP Regional Operations
Phone
(505) 923-5339

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 1T3328 NM Primary

Addresses

Primary practice location

301 E Miel de Luna Ave
Tucumcari, NM 88401-3810

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5364

Other names 1

  • TUCUMCARI HOSPICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100226000770 NM Part A Provider - Hospice 9234041708 Practice locations: Tucumcari, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184952368. Details of each certification follow.

Hospice certification: CCN 321566

Legal name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
TUCUMCARI HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 12, 2012
Last certification
Oct 23, 2019
Ownership / control type
Non-Profit - Private
Organization structure
OtherNon-profit
Enrollment address
301 E Miel de Luna
Tucumcari, NM 88401-2858

Care Compare: Hospice

Medicare Care Compare
Listed as
Tucumcari HospiceCCN 321566 · All quality measures
Ownership
Non-Profit
Certified
Apr 12, 2012
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Uzma Hannan MD69 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Kimberly Poland Individual Corporate DirectorManager Provider Enrollment Jan 1, 2011
W-2 Managing EmployeeManager Provider Enrollment Jan 1, 2011
Brad Bryant Individual Corporate Director Jan 1, 2010
Will Cantrell Individual Corporate Director Jan 1, 2010
Steven Figge Individual Corporate DirectorDirector Mso Jan 1, 2010
W-2 Managing EmployeeDirector Mso Jan 1, 2010
Thomas Sidwell Individual Corporate Director Jan 1, 2010
Edward B Cazzola Individual W-2 Managing Employee Jan 1, 2010
Presbyterian Healthcare Services Organization, Albuquerque, NM 5% Or Greater Direct Ownership Interest Dec 1, 2009
Operational/Managerial Control Dec 1, 2009

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Presbyterian Espanola HospitalEspanola, NM, CCN 320011 Hospital Operational/Managerial Control May 24, 1948
Plains Regional Medical Center ClovisClovis, NM, CCN 320022 Hospital Operational/Managerial Control Jan 1, 1978
Socorro General HospitalSocorro, NM, CCN 32Z301 Hospital Operational/Managerial Control Mar 30, 2000
Socorro General HospitalSocorro, NM, CCN 321301 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 321302 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 32Z302 Hospital Operational/Managerial Control Mar 15, 2000
Socorro General Hospital Home HealthcareSocorro, NM, CCN 327027 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 1, 2000
Jan 19, 2009
Plains Regional Medical Center Clovis Home HealthcareClovis, NM, CCN 327305 Home health agency 5% Or Greater Direct Ownership Interest Feb 14, 1979

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1259107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305676800000",
    "number": "1184952368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-5364",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E MIEL DE LUNA AVE",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884013810",
            "telephone_number": "575-461-7240",
            "fax_number": "575-461-7245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-25",
        "last_updated": "2011-05-18",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "VP REGIONAL OPERATIONS",
        "authorized_official_telephone_number": "505-923-5339"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NM",
            "license": "1T3328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TUCUMCARI HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucumcari, NM

Sources for this page

Verify at the official NPI Registry.