NPIMap

Organization Active NPI

Roosevelt County Special Hospital District

Doing business as RGH Internal Medicine Group

  • Rural Health Clinic/Center
  • Portales, NM
National Provider Identifier
1316013402
Registry record updated Aug 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT
Doing business as
RGH Internal Medicine Group
Practice address
42121 US Hwy 70
Portales, NM 88130-9347
Phone
(575) 359-1800
Fax
(575) 356-9200
NPI assigned
Nov 28, 2006
Last updated
Aug 10, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2015

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • RGH Internal Medicine Group Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316013402. Details of each certification follow.

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
OtherNon-profit
Enrollment address
42121 US Highway 70
Portales, NM 88130-9054
Related CCNs
320084

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Roosevelt Co Spec Hosp Dist2 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.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

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 DirectorChief Executive Officer Jun 5, 2017 100%
Operational/Managerial ControlCeo Jun 5, 2017 100%
Jessica Camacho Individual Corporate DirectorDirector 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 HospitalPortales, NM, CCN 320084 Hospital Operational/Managerial Control (100%) Jun 7, 2017
Roosevelt General HospitalPortales, NM, CCN 32U084 Hospital Operational/Managerial Control (100%) Jun 7, 2017
RHG Clovis ClinicClovis, NM, CCN 323410 Rural health clinic Operational/Managerial Control (100%) May 6, 2019

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439164800000",
    "number": "1316013402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42121 US HWY 70",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881300299",
            "telephone_number": "575-359-1800",
            "fax_number": "575-356-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42121 US HWY 70",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881309347",
            "telephone_number": "575-359-1800",
            "fax_number": "575-356-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT COUNTY SPECIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-08-10",
        "status": "A",
        "authorized_official_last_name": "LEARNING",
        "authorized_official_first_name": "LORENCE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-356-3412"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RGH Internal Medicine Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portales, NM

Sources for this page

Verify at the official NPI Registry.