NPIMap

Organization Active NPI

La Clinica Tepeyac, Inc

  • Federally Qualified Health Center (FQHC)
  • Denver, CO
National Provider Identifier
1659080620
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA TEPEYAC, INC
Practice address
2101 E. 48TH Av.
Denver, CO 80216
Phone
(303) 458-5302
NPI assigned
Nov 18, 2022
Organization subpart
Yes
Parent organization
LA CLINICA TEPEYAC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Authorized official

Name
James Garcia
Title
Ceo
Phone
(303) 458-5302

Specialties & licenses 1

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

Addresses

Primary practice location

2101 E. 48TH Av.
Denver, CO 80216

Mailing address

4725 High St
Denver, CO 80216-2220
Phone (303) 458-5302

Other names 1

  • Tepeyac Community Health Center - East 48th Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150218000141 CO Part B Supplier - Clinic/Group Practice 4082939962 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Denver, CO
O20230405002343 CO Part A Provider - Federally Qualified Health Center (FQHC) 4082939962 Practice locations: Denver, CO

Federally qualified health center certification: CCN 061047

Legal name
LA CLINICA TEPEYAC, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2023
Last certification
Apr 4, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2101 E 48TH Ave
Denver, CO 80216-2253

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
La Clinica Tepeyac Inc

Locations

4725 High St
Denver, CO 80216
Phone (720) 274-2923

5075 Lincoln St
Denver, CO 80216
Phone (303) 458-5302

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Dickie Montemayor Individual Other Aug 15, 2015
Carola Donohoo Individual Corporate Officer Feb 16, 2016
W-2 Managing Employee Dec 6, 2016
Elisa Guardiola Melendez Individual Other Aug 15, 2015
Tyler Lee Erb Individual Other Aug 15, 2015
Ann Barbara Murphy Individual Other Aug 15, 2015
Estevan T Flores Individual Other Aug 15, 2015
James Garcia Individual 5% Or Greater Direct Ownership InterestChief Executive Officer Aug 1, 2015
Christopher E Urbina Individual Other Aug 15, 2015
Pamela L Valenza Individual Corporate Director Feb 19, 2018
David Arnold Martinez Individual Other Aug 15, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1659080620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4725 HIGH ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802162220",
            "telephone_number": "303-458-5302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 E. 48TH AV.",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80216",
            "telephone_number": "303-458-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA CLINICA TEPEYAC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LA CLINICA TEPEYAC, INC",
        "enumeration_date": "2022-11-18",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-458-5302"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tepeyac Community Health Center - East 48th",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.