NPIMap

Organization Active NPI

San Juan Medical Group PC

Doing business as Farmington Family Practice

  • Family Medicine Physician
  • Farmington, NM
National Provider Identifier
1609809235
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
47359 Issued in NM
Legal business name
SAN JUAN MEDICAL GROUP PC
Doing business as
Farmington Family Practice
Practice address
622 W Maple St
Suite B
Farmington, NM 87401-6590
Phone
(505) 327-4867
Fax
(505) 327-5355
NPI assigned
Jul 8, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Robert Joseph Burns, M.D.NPI 1659396992
Title
President
Phone
(505) 327-4867

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 47359 NM Primary

Addresses

Primary practice location

622 W Maple St
Suite B
Farmington, NM 87401-6590

Mailing address

622 W Maple St
Suite B
Farmington, NM 87401-6590
Phone (505) 327-4867

Other names 1

  • FARMINGTON FAMILY PRACTICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050708000819 NM Part B Supplier - Clinic/Group Practice 2264468503 Receives reassigned benefits from 11 practitioners
Practice locations: Farmington, NM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D0536156San Juan Medical Group Inc622 West Maple St Ste B, Farmington, NM 87401AccreditationNov 2, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1609809235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST",
            "address_2": "SUITE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016590",
            "telephone_number": "505-327-4867",
            "fax_number": "505-327-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W MAPLE ST",
            "address_2": "SUITE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016590",
            "telephone_number": "505-327-4867",
            "fax_number": "505-327-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-327-4867",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "47359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FARMINGTON FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.