NPIMap

Organization Active NPI

St Vincent Hospital

Doing business as CHRISTUS St. Vincent Center for Healthy Aging

  • Adult Medicine Physician
  • Santa Fe, NM
National Provider Identifier
1194599712
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
ST VINCENT HOSPITAL
Doing business as
CHRISTUS St. Vincent Center for Healthy Aging
Practice address
1692 Hospital Dr BLDG a
Santa Fe, NM 87505-4754
Phone
(505) 913-3401
Fax
(505) 913-6950
NPI assigned
Nov 14, 2023
Last updated
Nov 14, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Authorized official

Name
Carla L Gomez
Title
Pe Supervisor
Phone
(505) 913-5227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X Primary

Addresses

Primary practice location

1692 Hospital Dr BLDG a
Santa Fe, NM 87505-4754

Mailing address

455 Saint Michaels Dr
Santa Fe, NM 87505-7601
Phone (505) 913-5227

Other names 1

  • CHRISTUS St. Vincent Center for Healthy Aging Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040105000372 NM Part B Supplier - Clinic/Group Practice 6608775135 Receives reassigned benefits from 425 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Santa Fe, NM; Los Alamos, NM; Albuquerque, NM; Espanola, NM; Farmington, NM; Las Vegas, NM

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
32D2285964Christus St Vincent Center for Healthy Aging1692 Hospital Drive, Building a, Santa Fe, NM 87505Certificate of waiverSep 12, 2026

National Provider Directory

National Provider Directory
Tax ID family
William F Johnson28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 2

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": "1699920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1194599712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 SAINT MICHAELS DR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875057601",
            "telephone_number": "505-913-5227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1692 HOSPITAL DR BLDG A",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054754",
            "telephone_number": "505-913-3401",
            "fax_number": "505-913-6950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST VINCENT HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PE SUPERVISOR",
        "authorized_official_telephone_number": "505-913-5227"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHRISTUS St. Vincent Center for Healthy Aging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Fe, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.