NPIMap

Organization Active NPI

La Clinica de Familia, Incorporated

Doing business as La Clinica De Familia Chaparral Medical

  • Federally Qualified Health Center (FQHC)
  • Chaparral, NM
National Provider Identifier
1508838004
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DE FAMILIA, INCORPORATED
Doing business as
La Clinica De Familia Chaparral Medical
Practice address
510 E Lisa Dr
Chaparral, NM 88081-7809
Phone
(575) 824-0820
Fax
(575) 824-1021
NPI assigned
Feb 7, 2006
Last updated
Jun 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

Name
Virgil Medina
Title
Chief Executive Officer
Phone
(575) 526-1105

Specialties & licenses 1

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

Addresses

Primary practice location

510 E Lisa Dr
Chaparral, NM 88081-7809

Mailing address

385 Calle de Alegra
BLDG. a
Las Cruces, NM 88005-3423
Phone (575) 526-1105

Other practice location 1

510 E Lisa Dr Bldg 2
Chaparral, NM 88081-7809
Phone (575) 824-0820

Other identifiers 1

IdentifierTypeStateIssuer
R8204MedicaidNM

Other names 1

  • La Clinica De Familia Chaparral Medical Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031231000076 NM Part B Supplier - Clinic/Group Practice 6305745191 Receives reassigned benefits from 141 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sunland Park, NM; Santa Teresa, NM; Mesilla, NM; Las Cruces, NM; Anthony, NM; Chaparral, NM; La Mesa, NM
O20040615001603 NM Part A Provider - Federally Qualified Health Center (FQHC) 6305745191 Practice locations: Chaparral, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508838004. Details of each certification follow.

Federally qualified health center certification: CCN 321865

Legal name
LA CLINICA DE FAMILIA INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 20, 1997
Last certification
Jun 20, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1978 in NM
Enrollment address
510 E Lisa Dr
Chaparral, NM 88081-7809

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
La Clinica de Familia Incorporated48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

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

View all 47

Locations

385 Calle de Alegra
Bldg C
Las Cruces, NM 88005
Phone (575) 521-7181

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Alberto Renteria Individual Corporate Director Jun 16, 2010
Jesus Prieto Individual Corporate Director Jun 16, 2010
Virgil Medina Individual Corporate OfficerCeo Apr 28, 2017
Operational/Managerial ControlCeo Apr 28, 2017
Edward Ybarra Individual Corporate Director Jun 16, 2010

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
LCDF Gadsden School BaseAnthony, NM, CCN 321951 Federally qualified health center Operational/Managerial Control Aug 1, 2016
La Clinica de Familia IncorporatedChaparral, NM, CCN 321954 Federally qualified health center Operational/Managerial Control Jul 1, 2016
La Clinica de Familia IncorporatedAnthony, NM, CCN 321968 Federally qualified health center Operational/Managerial Control Oct 22, 2019
Picacho Middle School - School Base Health CenterLas Cruces, NM, CCN 321002 Federally qualified health center Operational/Managerial Control Jul 12, 2023
Mayfield High School - School Based Health CenterLas Cruces, NM, CCN 321014 Federally qualified health center Operational/Managerial Control Sep 1, 2025
Organ Mountain High School - School Based Health CenterLas Cruces, NM, CCN 321015 Federally qualified health center Operational/Managerial Control Sep 1, 2025

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 7

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": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1508838004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 CALLE DE ALEGRA",
            "address_2": "BLDG. A",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880053423",
            "telephone_number": "575-526-1105",
            "fax_number": "575-524-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E LISA DR",
            "city": "CHAPARRAL",
            "state": "NM",
            "postal_code": "880817809",
            "telephone_number": "575-824-0820",
            "fax_number": "575-824-1021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 E Lisa Dr Bldg 2",
            "address_purpose": "LOCATION",
            "city": "Chaparral",
            "state": "NM",
            "postal_code": "880817809",
            "country_code": "US",
            "telephone_number": "575-824-0820",
            "fax_number": "575-824-1021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LA CLINICA DE FAMILIA, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "575-526-1105"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "R8204",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Clinica De Familia Chaparral Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "La Clinica De Familia Chaparral Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chaparral, NM

Sources for this page

Verify at the official NPI Registry.