Presbyterian Medical Services

Key facts

NPI: 1295849933
Entity type: Organization (NPI type 2)
Primary specialty: Federally Qualified Health Center (FQHC) 261QF0400X
License: 6318 A1 (NM)
Legal business name: PRESBYTERIAN MEDICAL SERVICES
Practice address: 2013 San Jose Blvd
Carlsbad, NM 88220-5426
Phone: (505) 887-2455
Fax: (505) 234-2945
NPI assigned: Aug 19, 2006
Organization subpart: No

Authorized official

Name: Doug Smith
Title: Executive Vice President
Phone: (505) 982-5565

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NM

Federally qualified health center certification: CCN 321820

Legal name: PRESBYTERIAN MEDICAL SERVICES
Doing business as: CARLSBAD FAMILY HEALTH CENTER
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: Corporation · Non-profit
Incorporated: Aug 1, 1969 in NM
Enrollment address: 2013 San Jose Blvd
Carlsbad, NM 88220-5426

All disclosed owners & managing parties 12

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

Name	Role	Since
Roberta Lee Individual	Corporate Director Board Member	Oct 1, 2022
Steven C Hansen Individual	Corporate Officer President	Nov 1, 2007
Scott Michlin Individual	Corporate Director Board Member	Aug 22, 2011
Doug Smith Individual	Corporate Officer Executive Vice President & Treas	Aug 22, 2011
Marlene Waukazoo Individual	Corporate Director Board Member	Nov 1, 2012
Bryan Romkey Individual	Corporate Director Board Member	Feb 5, 2015
Lillie Lewis Individual	Corporate Director Board Member	May 2, 2013
Frank McCasland Individual	Corporate Director Board Member	Aug 22, 2011
Melissa Sharpe Individual	Corporate Director Board Member	Feb 5, 2015
Susan K Smith Individual	Corporate Director Board Member	Aug 22, 2011
Cynthia Rael-Vigil Individual	Corporate Director Board Member	Aug 22, 2011
Kent E Mosbrucker Individual	W-2 Managing Employee Vice President of Finance	Aug 31, 2018

All facility ownership & control disclosures 1

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

Facility	Type	Role	Since
Santa Fe Family Health Center Sante Fe, NM · CCN 321950	Federally qualified health center	5% Or Greater Direct Ownership Interest	Oct 1, 2012

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20061108000467	NM	Part a Provider - Federally Qualified Health Center (FQHC)	2062324684	Practice locations: Carlsbad, NM

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Federally Qualified Health Center (FQHC)	261QF0400X	6318 A1	NM	Yes

Addresses

Primary practice location

2013 San Jose Blvd
Carlsbad, NM 88220-5426

Mailing address

PO Box 2267
Santa Fe, NM 87504-2267
Phone (505) 982-5565

Other identifiers

Identifier	Type	State	Issuer
50419	Medicaid	NM

Other names

Carlsbad Family Health Center Doing business as

Other providers in Carlsbad, NM

All providers in Carlsbad, NM · Federally Qualified Health Center (FQHC) in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.