NPIMap

Organization Active NPI

Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Las Cruces, NM
National Provider Identifier
1487026563
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BEN ARCHER HEALTH CENTER
Practice address
3331 Del Rey Blvd.
Las Cruces, NM 88012
Phone
(575) 267-3280
NPI assigned
Oct 28, 2015
Last updated
Oct 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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

Authorized official

Name
Jody Koenig
Title
Financial Officer
Phone
(575) 267-3280

Specialties & licenses 1

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

Addresses

Primary practice location

3331 Del Rey Blvd.
Las Cruces, NM 88012

Mailing address

PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160218002300 NM Part A Provider - Federally Qualified Health Center (FQHC) 7517878796 Practice locations: Las Cruces, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487026563. Details of each certification follow.

Federally qualified health center certification: CCN 321941

Legal name
BEN ARCHER HEALTH CENTER
Doing business as
BEN ARCHER HEALTH CENTER EAST LAS CRUCES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 8, 2016
Last certification
Feb 8, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1973 in NM
Enrollment address
3331 Del Rey Blvd
Las Cruces, NM 88012-7713

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Ben Archer Health Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Christina Fierro Individual Corporate DirectorBoard Member Jan 20, 2007
Vicente Zamora Individual Corporate Director Feb 1, 2021
Mary Alice Garay Individual 5% Or Greater Direct Ownership InterestCeo Jun 1, 1993
W-2 Managing EmployeeCeo Jun 1, 1993
Sylvia McGuire Individual Corporate DirectorBoard Member Sep 27, 2012
Shawna Runyan Individual Corporate Director Feb 1, 2021
Bobby Cordero Individual Corporate Director Feb 1, 2021
Patricia Leyba Individual Corporate DirectorBoard Member Apr 1, 2001
Elwin Roach Individual Corporate DirectorBoard Member Jan 20, 2002
Ryan Jaramillo Individual Corporate Director Feb 1, 2021

Practitioners & affiliated clinicians

Practitioners 1

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": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1487026563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "HATCH",
            "state": "NM",
            "postal_code": "879370370",
            "telephone_number": "575-267-3280",
            "fax_number": "575-267-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3331 DEL REY BLVD.",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "88012",
            "telephone_number": "575-267-3280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEN ARCHER HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "KOENIG",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "FINANCIAL OFFICER",
        "authorized_official_telephone_number": "575-267-3280"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.