Presbyterian Medical Services

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

6318 A1 Issued in NM

Legal business name

PRESBYTERIAN MEDICAL SERVICES

Doing business as

Carlsbad Family Health Center

Practice address

2013 San Jose Blvd
Carlsbad, NM 88220-5426

Phone

(505) 887-2455

Fax

(505) 234-2945

NPI assigned

Aug 19, 2006

Last updated

Jan 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Doug Smith

Title

Executive Vice President

Phone

(505) 982-5565

Specialties & licenses 1

Addresses

Other names 1

• Carlsbad Family Health Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295849933. Details of each certification follow.

• CCN 321820 Federally qualified health center · Active · Details

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

CorporationNon-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.

All facility ownership & control disclosures 1

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

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610150400000",
    "number": "1295849933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2267",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875042267",
            "telephone_number": "505-982-5565",
            "fax_number": "505-992-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2013 SAN JOSE BLVD",
            "city": "CARLSBAD",
            "state": "NM",
            "postal_code": "882205426",
            "telephone_number": "505-887-2455",
            "fax_number": "505-234-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2021-01-09",
        "certification_date": "2021-01-09",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "505-982-5565"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "6318 A1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carlsbad Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carlsbad Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ashley Pryor

• Federally Qualified Health Center (FQHC) in Carlsbad, NM
• Providers in Carlsbad, NM by specialty
• Federally Qualified Health Center (FQHC) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.