Ramah Navajo School Board, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Pine Hill, NM
NPI 1619001849 · NPPES record last updated Sep 27, 2017
Key facts
- NPI
- 1619001849
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RAMAH NAVAJO SCHOOL BOARD, INC
- Practice address
- 12 Bia 120
PO Box 310
Pine Hill, NM 87357-0310 - Phone
- (505) 775-3271
- Fax
- (505) 775-3233
- NPI assigned
- Mar 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. William Becker
- Title
- Chief Health Administrator
- Phone
- (505) 775-3271
Corporate family (same tax ID) 3
Practitioners 12
-
Katheryne Anne Barron, N.P.
-
Michael Ray, FNP-BC
-
Jennifer Renee Schafer, FNP-BC
-
Robert Edward Curtis, M.D.
-
Arlene Leola Blanton, R.N.
-
William Lloyd Cloud Jr., D.D.S.
-
Jean Proper, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NM, TX
Federally qualified health center certification: CCN 321845
- Legal name
- RAMAH NAVAJO SCHOOL BOARD, INC
- Doing business as
- PINE HILL HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 6, 1970 in NM
- Enrollment address
- 140 Bia Rte
Pinehill, NM 87357
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Carolyn Coho |
Corporate Director | Jan 1, 2022 | |
| Clyde Yatsattie |
Corporate Director |
Jan 1, 2025 | |
| W-2 Managing Employee |
Feb 1, 2025 | ||
| Sarah Adeky |
Corporate Director | Jan 1, 2022 | |
| Victoria Henio |
5% Or Greater Direct Ownership Interest |
Jan 1, 2024 | |
| Corporate Director | Jan 1, 2022 | ||
| Martha Garcia |
Corporate Director | Jan 1, 2022 | |
| Germundson Jake |
Corporate Director | Jan 1, 2022 | |
| Kristi Martine |
W-2 Managing Employee |
Feb 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060505000037 | NM | Part B Supplier - Clinic/Group Practice | 1153332150 |
Receives reassigned benefits from 6 practitioners Practice locations: Pinehill, NM |
| O20101029001305 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 1153332150 | Practice locations: Pinehill, NM |
| O20110627000038 | TX | Part B Supplier - Ambulance Service Supplier | 1153332150 | Practice locations: Pine Hill, NM |
National Provider Directory
- Tax ID family
- Ramah Navajo School Board I
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | NM | Yes | |
| Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 332800000X | |||
| Land Ambulance | 3416L0300X | NM |
Addresses
Primary practice location
12 Bia 120
PO Box 310
Pine Hill, NM 87357-0310
Mailing address
PO Box 310
Pine Hill, NM 87357-0310
Phone (505) 775-3271
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00055587 | Medicaid | NM | |
| R0829 | Medicaid | NM |
Other names
- Pine Hill Health Center
Other providers in Pine Hill, NM
- William Lloyd Cloud Jr.
- Triston Shane Eriacho
- Ivan John Christov Nicolov
- Michael John Nolan
- Pine Hill Health Center
- Christine Thomas Roper
- Jill Sanders
- Anderson Thomas
- Kristi Michelle Turney
- Jeff Westbrook
All providers in Pine Hill, NM · Federally Qualified Health Center (FQHC) in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.