NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Presbyterian Medical Services Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Rio Rancho, NM
National Provider Identifier
1477975688
Registry record updated Jan 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Presbyterian Medical Services Family Health Center
Practice address
2300 Grande Blvd SE
Rio Rancho, NM 87124-1636
Phone
(505) 896-0928
NPI assigned
Jan 8, 2014
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) 820-3447

Specialties & licenses 1

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

Addresses

Primary practice location

2300 Grande Blvd SE
Rio Rancho, NM 87124-1636

Mailing address

PO Box 2267
Santa Fe, NM 87504-2267
Phone (505) 982-5565

Other names 1

  • Presbyterian Medical Services Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000414 NM Part B Supplier - Clinic/Group Practice 2062324684 Receives reassigned benefits from 340 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Fe, NM; Socorro, NM; Rio Rancho, NM; Pecos, NM; Espanola, NM; Deming, NM; Carlsbad, NM; Albuquerque, NM…
O20140225000091 NM Part A Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Rio Rancho, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477975688. Details of each certification follow.

Federally qualified health center certification: CCN 321928

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
PRESBYTERIAN MEDICAL SERVICES FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2014
Last certification
Feb 24, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
2300 Grande Blvd SE
Rio Rancho, NM 87124-1636

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Nadine Ulibarri Keller Individual Corporate DirectorBoard Member Aug 22, 2011
Anthony Armijo Individual Corporate DirectorBoard Member Aug 22, 2011
Robert Mitchell Individual Corporate DirectorBoard Member Aug 22, 2011
Steven C Hansen Individual Corporate OfficerPresident Nov 1, 2007
Scott Michlin Individual Corporate DirectorBoard Member Aug 22, 2011
Doug Smith Individual Corporate OfficerExecutive Vice President & Treas Aug 22, 2011
Laura Jaramillo Individual Corporate DirectorBoard Member Nov 1, 2021
Marlene Waukazoo Individual Corporate DirectorBoard Member Nov 1, 2012
Diane Lopez Individual Corporate OfficerVice President & Corporate Secre Aug 22, 2011
Hilda Keller Individual Corporate DirectorBoard Member Jul 1, 2021
Frank McCasland Individual Corporate DirectorBoard Member Aug 22, 2011
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 EmployeeVP 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

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1389139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610150400000",
    "number": "1477975688",
    "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",
            "telephone_number": "505-982-5565",
            "fax_number": "505-992-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 GRANDE BLVD SE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241636",
            "telephone_number": "505-896-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-08",
        "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": "505-820-3447"
    },
    "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": "Presbyterian Medical Services Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Presbyterian Medical Services Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rio Rancho, NM

Sources for this page

Verify at the official NPI Registry.