NPIMap

Organization Active NPI

Clinica Campesina Family Health Services

Doing business as Clinica Family Health

  • Federally Qualified Health Center (FQHC)
  • Boulder, CO
National Provider Identifier
1659649135
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Doing business as
Clinica Family Health
Practice address
1333 Iris Ave
Boulder, CO 80304-2226
Phone
(303) 665-3036
NPI assigned
Dec 12, 2011
Last updated
Feb 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
Brian J Johnston
Title
Cfo
Phone
(303) 926-0625

Specialties & licenses 1

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

Addresses

Primary practice location

1333 Iris Ave
Boulder, CO 80304-2226

Mailing address

1735 S Public Rd
Lafayette, CO 80026-7093

Other names 1

  • Clinica Family Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000276 CO Part B Supplier - Clinic/Group Practice 7315850484 Receives reassigned benefits from 246 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Broomfield, CO; Longmont, CO; Lafayette, CO; Boulder, CO
O20120313000410 CO Part A Provider - Federally Qualified Health Center (FQHC) 7315850484 Practice locations: Boulder, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659649135. Details of each certification follow.

Federally qualified health center certification: CCN 061920

Legal name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Doing business as
CLINICA FAMILY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 24, 2012
Last certification
Apr 24, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1977 in CO
Enrollment address
1333 Iris Ave
Boulder, CO 80304-2226

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Clinica Campesina Fam H27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

1345 Plaza Ct N
Ste 1A
Lafayette, CO 80026
Phone (303) 665-2962

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Inez D Buggs Individual Corporate DirectorBoard Member Feb 24, 2012
Jeff Zayach Individual Corporate DirectorBoard Member Aug 1, 2021
Carolina Flores Manross Individual Corporate DirectorBoard Member Aug 1, 2020
Douglas Jones Individual Corporate DirectorBoard Member Sep 1, 2011
Ella Padilla Individual Corporate DirectorBoard Member Sep 1, 2018
Matthew Antush Individual Corporate DirectorBoard Member Jul 1, 2019
Heather Elkins Individual Corporate DirectorBoard Member Apr 1, 2017
Brian Johnston Individual Corporate DirectorCfo Nov 29, 2022
W-2 Managing EmployeeCfo Nov 29, 2022
Cherlyn a Marriott Individual Corporate DirectorChairman of the Board Feb 24, 2012
Lizandro Gonzalez Individual Corporate DirectorBoard Member Aug 1, 2020
Edson Hernandez Individual Corporate DirectorBoard Member Oct 1, 2017
Mayra Martinez Individual Corporate DirectorBoard Member Aug 1, 2016
Heidy Ordonez Individual Corporate DirectorBoard Member Aug 1, 2021
Simon G Smith Individual Corporate OfficerCeo Oct 1, 2013
W-2 Managing EmployeeCeo Oct 1, 2013
Operational/Managerial ControlCeo Oct 1, 2013 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Clinica Family HealthNederland, CO, CCN 061033 Federally qualified health center Other Jun 1, 2022
Clinica Family Health ServicesBlack Hawk, CO, CCN 061034 Federally qualified health center Other Jun 1, 2022

Owned or controlled facilities with NPI records 2

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": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1659649135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 IRIS AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803042226",
            "telephone_number": "303-665-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA CAMPESINA FAMILY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-12",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-926-0625"
    },
    "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": "Clinica Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.