NPIMap

Organization Active NPI

El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Roy, NM
National Provider Identifier
1275798969
Registry record updated Nov 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6103 Issued in NM
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
555 Wagon Mound Highway
Roy, NM 87743-0148
Phone
(575) 485-2484
Fax
(575) 485-2261
NPI assigned
Jul 23, 2008
Last updated
Nov 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2014

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

Authorized official

Name
Mrs. Lore Pease
Title
Ceo
Phone
(505) 753-7218

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6103 NM Primary

Addresses

Primary practice location

555 Wagon Mound Highway
Roy, NM 87743-0148

Mailing address

538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218

Other identifiers 2

IdentifierTypeStateIssuer
45542MedicaidNM
1780689034OtherNMORGANIZATION NPPES

Other names 1

  • El Centro Family Health Roy Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090113000840 NM Part A Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Roy, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275798969. Details of each certification follow.

Federally qualified health center certification: CCN 321834

Legal name
EL CENTRO FAMILY HEALTH
Doing business as
EL CENTRO FAMILY HEALTH ROY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1972 in NM
Enrollment address
555 Wagon Mound Hwy
Roy, NM 87743

Other NPIs with the same Medicare PAC ID 18

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

View all 18

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Paul a Guiles Individual Corporate DirectorBoard Member Aug 1, 2008
Sylvia a Vigil Individual Corporate DirectorBoard Member Jan 1, 2013
Evaristo Maestas Individual Corporate DirectorBoard Member Mar 1, 2009
Nesha Morse Individual Corporate DirectorBoard Member Dec 1, 2013
Lore Pease Individual Corporate OfficerCeo Dec 15, 2008
Corporate DirectorCeo Dec 15, 2008
W-2 Managing EmployeeCeo Dec 15, 2008
Lebeo Martinez Individual Corporate DirectorBoard Member Dec 17, 2008
Richard C Frey Individual Corporate DirectorBoard Member Dec 17, 2008
Pearl Maestas Individual Corporate DirectorBoard Member Nov 1, 2011
Francine Kain Individual Corporate OfficerCfo Sep 10, 2011
Lynsey Wheeler Individual Corporate DirectorBoard Member Aug 1, 2012
Lucille Montoya Individual W-2 Managing EmployeeCoo May 7, 2014
Sinforosa Lovato Individual Corporate DirectorBoard Member Feb 1, 1985
Jackie Feeler Individual Corporate DirectorBoard Member Feb 1, 2013
Janette Archuleta Individual Corporate DirectorBoard Member Mar 1, 2012

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Robertson High School Based ClinicLas Vegas, NM, CCN 321952 Federally qualified health center Operational/Managerial Control Sep 7, 2016

Owned or controlled facilities with NPI records 1

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

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": "1216771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416528000000",
    "number": "1275798969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N PASEO DE ONATE",
            "address_2": "P.O. BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322618",
            "telephone_number": "505-753-7218",
            "fax_number": "505-753-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 WAGON MOUND HIGHWAY",
            "city": "ROY",
            "state": "NM",
            "postal_code": "877430148",
            "telephone_number": "575-485-2484",
            "fax_number": "575-485-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-23",
        "last_updated": "2014-11-21",
        "status": "A",
        "authorized_official_last_name": "PEASE",
        "authorized_official_first_name": "LORE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-753-7218",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "6103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45542",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION NPPES",
            "identifier": "1780689034",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Family Health Roy Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roy, NM

Sources for this page

Verify at the official NPI Registry.