NPIMap

Organization Active NPI

State of New Mexico

Doing business as New Mexico Behavioral Health Institue at Las Vegas

  • Clinical Medical Laboratory
  • Las Vegas, NM
National Provider Identifier
1407057607
Registry record updated Apr 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
32D0653275 Issued in NM
Legal business name
STATE OF NEW MEXICO
Doing business as
New Mexico Behavioral Health Institue at Las Vegas
Practice address
3695 Hot Springs Blvd
Las Vegas, NM 87701-9549
Phone
(505) 454-2100
NPI assigned
May 29, 2007
Last updated
Apr 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2009

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

Authorized official

Name
Mr. Charles R. Jaramillo
Title
Finance Director
Phone
(505) 454-2306

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 32D0653275 NM Primary

Addresses

Primary practice location

3695 Hot Springs Blvd
Las Vegas, NM 87701-9549

Mailing address

3695 Hot Springs Blvd
Las Vegas, NM 87701-9549
Phone (505) 454-2100

Other identifiers 1

IdentifierTypeStateIssuer
52431MedicaidNM

Other names 1

  • New Mexico Behavioral Health Institue at Las Vegas Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101102000228 NM Part B Supplier - Independent Clinical Laboratory 2062412869 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NM

Other NPIs with the same Medicare PAC ID 1

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

  • State of New Mexico

    dba NM Behavioral Health Institute at Las Vegas

    • Nursing Facility/Intermediate Care Facility
    • Las Vegas, NM
    • NPI 1992867998

    2062412869

    Same PAC ID

National Provider Directory

National Provider Directory
Tax ID family
Las Vegas Medical Cente10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
NM Behavioral Health Institute at Las VegasLas Vegas, NM, CCN 325104 Skilled nursing facility Operational/Managerial Control Aug 24, 2009

Owned or controlled facilities with NPI records 1

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

  • State of New Mexico

    dba NM Behavioral Health Institute at Las Vegas

    • Nursing Facility/Intermediate Care Facility
    • Las Vegas, NM
    • NPI 1992867998

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1407057607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3695 HOT SPRINGS BLVD",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877019549",
            "telephone_number": "505-454-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3695 HOT SPRINGS BLVD",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877019549",
            "telephone_number": "505-454-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW MEXICO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "JARAMILLO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "505-454-2306",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NM",
            "license": "32D0653275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52431",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Mexico Behavioral Health Institue at Las Vegas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NM

Sources for this page

Verify at the official NPI Registry.