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Roosevelt County Special Hospital District

Organization Active NPI Rural Health Clinic/Center · Portales, NM

NPI 1316013402 · NPPES record last updated Aug 10, 2015

Key facts

NPI
1316013402
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Practice address
42121 US Hwy 70
Portales, NM 88130-9347
Phone
(575) 359-1800
Fax
(575) 356-9200
NPI assigned
Nov 28, 2006
Organization subpart
No

Authorized official

Name
Lorence Learning
Title
Ceo
Phone
(575) 356-3412

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 1

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NM

Rural health clinic certification: CCN 323402

Legal name
ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 27, 2009
Last certification
Jan 12, 2023
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Enrollment address
42121 US Highway 70
Portales, NM 88130-9054
Related CCNs
320084

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Emilie Green
Individual 		Corporate Director
Chief Executive Officer		 Jun 5, 2017 100%
Operational/Managerial Control
Ceo		 Jun 5, 2017 100%
Jessica Camacho
Individual 		Corporate Director
Director of Business Office		 Oct 3, 2016 20%

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Roosevelt General Hospital
Portales, NM · CCN 320084		 Hospital Operational/Managerial Control (100%) Jun 7, 2017
Roosevelt General Hospital
Portales, NM · CCN 32U084		 Hospital Operational/Managerial Control (100%) Jun 7, 2017
RHG Clovis Clinic
Clovis, NM · CCN 323410		 Rural health clinic Operational/Managerial Control (100%) May 6, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20071010000409 NM Part a Provider - Rural Health Clinic 4082526660 Practice locations: Portales, NM

National Provider Directory

Tax ID family
Roosevelt General Hospi (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

42121 US Hwy 70
Portales, NM 88130-9347

Mailing address

42121 US Hwy 70
Portales, NM 88130-0299
Phone (575) 359-1800

Other names

  • RGH Internal Medicine Group Doing business as

Other providers in Portales, NM

All providers in Portales, NM · Rural Health Clinic/Center in New Mexico

Sources for this page

Verify at the official NPI Registry.