NPIMap

Organization Active NPI

El Centro Family Health

Doing business as Sierra Vista School Based Clinic

  • Federally Qualified Health Center (FQHC)
  • Las Vegas, NM
National Provider Identifier
1316475403
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EL CENTRO FAMILY HEALTH
Doing business as
Sierra Vista School Based Clinic
Practice address
475 Legion Dr.
Las Vegas, NM 87701
Phone
(505) 425-6788
NPI assigned
Jun 1, 2017
Last updated
Jun 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
EL CENTRO FAMILY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Authorized official

Name
Heather Rector
Title
Credentialing Specialist II
Phone
(505) 747-5946

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

475 Legion Dr.
Las Vegas, NM 87701

Mailing address

PO Box 158
Espanola, NM 87532-0158
Phone (505) 753-7218

Other names 1

  • Sierra Vista School Based Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171019002308 NM Part A Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Las Vegas, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316475403. Details of each certification follow.

Federally qualified health center certification: CCN 321957

Legal name
EL CENTRO FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2017
Last certification
Oct 17, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1972 in NM
Enrollment address
475 Legion Dr
Las Vegas, NM 87701

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
Tax ID family
El Centro Family Health10 organizations share this tax ID, including this one
Part of
El Centro Family Health

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 9

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 Director Aug 1, 2008
Sylvia a Vigil Individual Corporate Director Jan 1, 2013
Evaristo Maestas Individual Corporate Director Mar 1, 2009
Nesha Morse Individual Corporate Director Dec 1, 2013
Richard C Frey Individual Corporate Director Oct 1, 2008
Jerome Williams Individual Contracted Managing EmployeeCoo Dec 12, 2015
Corporate Director Dec 12, 2015
W-2 Managing Employee Dec 12, 2015
Operational/Managerial Control Dec 12, 2015
Juliet Garcia-Gonzales Individual Corporate Director Aug 26, 2015
Jackie Feeler Individual Corporate Director Feb 1, 2013
Janette Archuleta Individual Corporate Director 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 1

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": "1496275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1316475403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875320158",
            "telephone_number": "505-753-7218",
            "fax_number": "505-747-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 LEGION DR.",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "87701",
            "telephone_number": "505-425-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EL CENTRO FAMILY HEALTH",
        "enumeration_date": "2017-06-01",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "RECTOR",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST II",
        "authorized_official_telephone_number": "505-747-5946"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Vista School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sierra Vista School Based Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NM

Sources for this page

Verify at the official NPI Registry.