NPIMap

Organization Active NPI

Pueblo of San Felipe

  • Multi-Specialty Clinic/Center
  • San Felipe, NM
National Provider Identifier
1265511299
Registry record updated Jul 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PUEBLO OF SAN FELIPE
Practice address
3 Cedar Rd.
San Felipe, NM 87001
Phone
(505) 867-9616
Fax
(505) 771-9992
NPI assigned
Nov 2, 2006
Last updated
Jul 15, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2009

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

Authorized official

Name
Mr. Bruce D. Garcia
Title
Pueblo of San Felipe Tribal Admin
Phone
(505) 867-3381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

3 Cedar Rd.
San Felipe, NM 87001

Mailing address

PO Box 4339
San Felipe, NM 87001
Phone (505) 867-9616

Other identifiers 3

IdentifierTypeStateIssuer
81271875MedicaidNM
99624371MedicaidNM
81271875OtherNMPHARMACY

Other names 1

  • San Felipe Pueblo health & Wellness Department Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170106001735 TX Part B Supplier - Clinic/Group Practice 9739460668 Receives reassigned benefits from 3 practitioners
Practice locations: San Felipe Pueblo, NM

National Provider Directory

National Provider Directory
Tax ID family
Pueblo of San Felipe2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

  • Pueblo of San Felipe

    dba San Felipe Health Clinic Phcy

    • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
    • San Felipe, NM
    • NPI 1467550475
    NPD tax ID

Locations

133 Hagen Rd
San Felipe Pueblo, NM 87001
Phone (505) 771-7205

Practitioners & affiliated clinicians

Practitioners 7

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": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247616000000",
    "number": "1265511299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4339",
            "city": "SAN FELIPE",
            "state": "NM",
            "postal_code": "87001",
            "telephone_number": "505-867-9616",
            "fax_number": "505-771-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 CEDAR RD.",
            "city": "SAN FELIPE",
            "state": "NM",
            "postal_code": "87001",
            "telephone_number": "505-867-9616",
            "fax_number": "505-771-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO OF SAN FELIPE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2009-07-15",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PUEBLO OF SAN FELIPE TRIBAL ADMIN",
        "authorized_official_telephone_number": "505-867-3381",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81271875",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99624371",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY",
            "identifier": "81271875",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Felipe Pueblo health & Wellness Department",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Felipe, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.