NPIMap

Organization Active NPI

El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Espanola, NM
National Provider Identifier
1457798712
Registry record updated Nov 21, 2014
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
Practice address
1260 Industrial Park Rd
Espanola, NM 87532-3503
Phone
(505) 753-1348
Fax
(505) 747-7332
NPI assigned
May 28, 2013
Last updated
Nov 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2014

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

Authorized official

Name
Mrs. Lore Pease
Title
Ceo
Phone
(505) 753-7218

Specialties & licenses 1

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

Addresses

Primary practice location

1260 Industrial Park Rd
Espanola, NM 87532-3503

Mailing address

538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218

Other names 1

  • El Centro Family Health CVMHS SBHC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140917000184 NM Part A Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Espanola, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457798712. Details of each certification follow.

Federally qualified health center certification: CCN 321934

Legal name
EL CENTRO FAMILY HEALTH
Doing business as
EL CENTRO FAMILY HEALTH CARLOS VIGIL MIDDLE SCHOOL-BASED HEALTH CARE C
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 16, 2014
Last certification
Sep 16, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 6, 1975 in NM
Enrollment address
1260 Industrial Park Road
Espanola, NM 87532-3503

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

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 16

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 DirectorBoard Member Aug 1, 2008
Sylvia a Vigil Individual Corporate DirectorBoard Member Jan 1, 2013
Evaristo Maestas Individual Corporate DirectorBoard Member Mar 1, 2009
Nesha Morse Individual Corporate DirectorBoard Member Dec 1, 2013
Rosalie Lopez Individual Corporate DirectorBoard Member May 28, 2014
Lore Pease Individual Corporate OfficerCeo Jun 6, 2007
Lebeo Martinez Individual Corporate DirectorBoard Member Nov 1, 1994
Richard C Frey Individual Corporate DirectorBoard Member Oct 1, 2008
Gary Reece Individual Corporate DirectorBoard Member Mar 26, 2014
Pearl Maestas Individual Corporate DirectorBoard Member Nov 1, 2011
Francine Kain Individual Corporate OfficerCfo Oct 10, 2011
Lynsey Wheeler Individual Corporate DirectorBoard Member Aug 1, 2012
Lucille Montoya Individual W-2 Managing EmployeeChief Operations Manager Aug 24, 2011
Sinforosa Lovato Individual Corporate DirectorBoard Member Feb 1, 1985
Jackie Feeler Individual Corporate DirectorBoard Member Feb 1, 2013
Janette Archuleta Individual Corporate DirectorBoard Member 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 5

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": "1369699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416528000000",
    "number": "1457798712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N PASEO DE ONATE",
            "address_2": "P.O. BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322618",
            "telephone_number": "505-753-7218",
            "fax_number": "505-753-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 INDUSTRIAL PARK RD",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875323503",
            "telephone_number": "505-753-1348",
            "fax_number": "505-747-7332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-28",
        "last_updated": "2014-11-21",
        "status": "A",
        "authorized_official_last_name": "PEASE",
        "authorized_official_first_name": "LORE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-753-7218",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Family Health CVMHS SBHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Espanola, NM

Sources for this page

Verify at the official NPI Registry.