NPIMap

Organization Active NPI

La Clinica de Familia, Incorporated

Doing business as LCDF Picacho School Base

  • Federally Qualified Health Center (FQHC)
  • Las Cruces, NM
National Provider Identifier
1407562622
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DE FAMILIA, INCORPORATED
Doing business as
LCDF Picacho School Base
Practice address
1040 N Motel Blvd
Las Cruces, NM 88007-8144
Phone
(575) 526-1105
NPI assigned
Jan 31, 2023
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Virgil Medina
Title
Ceo
Phone
(575) 526-1105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1040 N Motel Blvd
Las Cruces, NM 88007-8144

Mailing address

385 Calle de Alegra Ste a
Las Cruces, NM 88005-3423
Phone (575) 526-1105

Other names 1

  • LCDF Picacho School Base Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231004003405 NM Part A Provider - Federally Qualified Health Center (FQHC) 6305745191 Practice locations: Las Cruces, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407562622. Details of each certification follow.

Federally qualified health center certification: CCN 321002

Legal name
LA CLINICA DE FAMILIA INCORPORATED
Doing business as
PICACHO MIDDLE SCHOOL - SCHOOL BASE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2023
Last certification
Sep 8, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1978 in NM
Enrollment address
1040 N Motel Blvd
Las Cruces, NM 88007-8144

Other NPIs with the same Medicare PAC ID 19

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

View all 19

National Provider Directory

National Provider Directory
Tax ID family
La Clinica de Familia Incorporated48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

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
Virgil Medina Individual Corporate OfficerCeo Jul 12, 2023
Operational/Managerial ControlCeo Jul 12, 2023 100%
La Clinica de Familia Incorporated Organization, Las Cruces, NM Corporation, Non-profit Operational/Managerial Control Jul 12, 2023

Owners & managing parties with NPI records 19

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 19

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
LCDF Gadsden School BaseAnthony, NM, CCN 321951 Federally qualified health center Operational/Managerial Control Aug 1, 2016
La Clinica de Familia IncorporatedChaparral, NM, CCN 321954 Federally qualified health center Operational/Managerial Control Jul 1, 2016
La Clinica de Familia IncorporatedAnthony, NM, CCN 321968 Federally qualified health center Operational/Managerial Control Oct 22, 2019
Mayfield High School - School Based Health CenterLas Cruces, NM, CCN 321014 Federally qualified health center Operational/Managerial Control Sep 1, 2025
Organ Mountain High School - School Based Health CenterLas Cruces, NM, CCN 321015 Federally qualified health center Operational/Managerial Control Sep 1, 2025

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1407562622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 CALLE DE ALEGRA STE A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053423",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 N MOTEL BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880078144",
            "telephone_number": "575-526-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA DE FAMILIA, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-526-1105"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LCDF Picacho School Base",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.