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Presbyterian Medical Services

Organization Active NPI Federally Qualified Health Center (FQHC) · Rio Rancho, NM

NPI 1477975688 · NPPES record last updated Jan 9, 2021

Key facts

NPI
1477975688
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Practice address
2300 Grande Blvd SE
Rio Rancho, NM 87124-1636
Phone
(505) 896-0928
NPI assigned
Jan 8, 2014
Organization subpart
No

Authorized official

Name
Doug Smith
Title
Executive Vice President
Phone
(505) 820-3447

Other NPIs on the same Medicare enrollment 9

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

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NM

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
Corporation · Non-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
2300 Grande Blvd SE
Rio Rancho, NM 87124-1636

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 Director
Board Member		 Aug 22, 2011
Anthony Armijo
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Robert Mitchell
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Steven C Hansen
Individual 		Corporate Officer
President		 Nov 1, 2007
Scott Michlin
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Doug Smith
Individual 		Corporate Officer
Executive Vice President & Treas		 Aug 22, 2011
Laura Jaramillo
Individual 		Corporate Director
Board Member		 Nov 1, 2021
Marlene Waukazoo
Individual 		Corporate Director
Board Member		 Nov 1, 2012
Diane Lopez
Individual 		Corporate Officer
Vice President & Corporate Secre		 Aug 22, 2011
Hilda Keller
Individual 		Corporate Director
Board Member		 Jul 1, 2021
Frank McCasland
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Susan K Smith
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Cynthia Rael-Vigil
Individual 		Corporate Director
Board Member		 Aug 22, 2011
Kent E Mosbrucker
Individual 		W-2 Managing Employee
VP 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 Center
Sante Fe, NM · CCN 321950		 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 2012

Medicare enrollment records

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

National Provider Directory

Locations

914 N Canal St
Carlsbad, NM 88220
Phone (575) 885-4836

2300 Grande Blvd SE
Rio Rancho, NM 87124
Phone (505) 331-8743

Specialties & licenses

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

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

  • Presbyterian Medical Services Family Health Center Doing business as

Other providers in Rio Rancho, NM

All providers in Rio Rancho, NM · Federally Qualified Health Center (FQHC) in New Mexico

Sources for this page

Verify at the official NPI Registry.