NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Sacramento Mountain Medical Center

  • Federally Qualified Health Center (FQHC)
  • Cloudcroft, NM
National Provider Identifier
1326115338
Registry record updated Jan 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
3033 Issued in NM
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Sacramento Mountain Medical Center
Practice address
74 James Canyon Hwy
Cloudcroft, NM 88317
Phone
(505) 682-2542
Fax
(505) 682-3075
NPI assigned
Nov 29, 2006
Last updated
Jan 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2021

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 3033 NM Primary
Non-Pharmacy Dispensing Site 332900000X CL00007514 NM

Addresses

Primary practice location

74 James Canyon Hwy
Cloudcroft, NM 88317

Mailing address

PO Box 2267
Santa Fe, NM 87504-2267

Other identifiers 2

IdentifierTypeStateIssuer
S7573MedicaidNM
3209776OtherOTHER ID NUMBER

Other names 1

  • SACRAMENTO MOUNTAIN MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110321000720 NM Part A Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Cloudcroft, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326115338. Details of each certification follow.

Federally qualified health center certification: CCN 321868

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
SACRAMENTO MOUNTAIN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1998
Last certification
Jan 1, 1998
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
74 James Canyon Hwy
Cloudcroft, NM 88317-0686

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D0969995Sacramento Mountain Medical Center74 James Canyon Highway, Cloudcroft, NM 88317Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pmscheckerboard Area H70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Anne Liley Individual Corporate DirectorBoard Member Feb 11, 2016
Mario Atencio Individual Corporate DirectorBoard Member Mar 12, 2019
Anthony Armijo Individual Corporate DirectorBoard Member Aug 22, 2011
Keith Riddle Individual Corporate DirectorBoard Member Aug 22, 2011
Steven C Hansen Individual Corporate OfficerPresident Nov 1, 2007
Michelle Maes Individual Corporate DirectorBoard Member Feb 11, 2016
Scott Michlin Individual Corporate DirectorBoard Member Aug 22, 2011
Doug Smith Individual Corporate OfficerExecutice Vice President & Treas Aug 22, 2011
Marlene Waukazoo Individual Corporate DirectorBoard Member Nov 1, 2012
Don Daniel Individual Corporate OfficerCorporate Secretary May 2, 2014
Diane Lopez Individual Corporate OfficerVice President & Corporate Secre Aug 22, 2011
Patricia Collins Individual Corporate DirectorBoard Member May 2, 2014
Bryan Romkey Individual Corporate DirectorBoard Member Feb 5, 2015
Lillie Lewis Individual Corporate DirectorBoard Member May 2, 2013
Frank McCasland Individual Corporate DirectorBoard Member Aug 22, 2011
Melissa Sharpe Individual Corporate DirectorBoard Member Feb 5, 2015
Daniel Evans Individual Corporate DirectorBoard Member Feb 1, 2017
Susan K Smith Individual Corporate DirectorBoard Member Aug 22, 2011
Cynthia Rael-Vigil Individual Corporate DirectorBoard Member Aug 22, 2011
Kent E Mosbrucker Individual W-2 Managing EmployeeVice 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.

FacilityTypeRoleSince
Santa Fe Family Health CenterSante Fe, NM, CCN 321950 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 2012

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610150400000",
    "number": "1326115338",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 JAMES CANYON HWY",
            "city": "CLOUDCROFT",
            "state": "NM",
            "postal_code": "88317",
            "telephone_number": "505-682-2542",
            "fax_number": "505-682-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "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": "3033",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NM",
            "license": "CL00007514",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "S7573",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3209776",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SACRAMENTO MOUNTAIN MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SACRAMENTO MOUNTAIN MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cloudcroft, NM

Sources for this page

Verify at the official NPI Registry.