NPIMap

Organization Active NPI

San Juan Regional Medical Center Inc

Doing business as San Juan Health Partners Walk-in Clinic

  • Family Medicine Physician
  • Bloomfield, NM
National Provider Identifier
1508219916
Registry record updated Jul 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAN JUAN REGIONAL MEDICAL CENTER INC
Doing business as
San Juan Health Partners Walk-in Clinic
Practice address
100 N Church St Ste C
Bloomfield, NM 87413-5754
Phone
(505) 609-6675
Fax
(505) 609-6579
NPI assigned
Jul 20, 2016
Last updated
Jul 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2016

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

Authorized official

Name
Karen S Miller
Title
Cfo
Phone
(505) 609-6114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

100 N Church St Ste C
Bloomfield, NM 87413-5754

Mailing address

PO Box 6210
Farmington, NM 87499-6210
Phone (505) 609-2258

Other names 1

  • SAN JUAN HEALTH PARTNERS WALK-IN CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040218000865 NM Part B Supplier - Clinic/Group Practice 4587559505 Receives reassigned benefits from 396 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farmington, NM; Bloomfield, NM; Aztec, NM

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
San Juan Region Med Ctr Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468972800000",
    "number": "1508219916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6210",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874996210",
            "telephone_number": "505-609-2258",
            "fax_number": "505-609-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N CHURCH ST STE C",
            "city": "BLOOMFIELD",
            "state": "NM",
            "postal_code": "874135754",
            "telephone_number": "505-609-6675",
            "fax_number": "505-609-6579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-20",
        "last_updated": "2016-07-20",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "505-609-6114"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAN JUAN HEALTH PARTNERS WALK-IN CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomfield, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.