El Centro Family Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

EL CENTRO FAMILY HEALTH

Doing business as

Springer SBHC

Practice address

1401 8TH Street
Springer, NM 87747

Phone

(505) 753-7218

Fax

(505) 747-5946

NPI assigned

Mar 12, 2019

Last updated

Mar 12, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jerome Tywan Williams

Title

Coo

Phone

(505) 747-5939

Specialties & licenses 1

Addresses

Other names 1

• Springer SBHC Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669930392. Details of each certification follow.

• CCN 321966 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 321966

Legal name

EL CENTRO FAMILY HEALTH-SPRINGER SBHC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jun 19, 2019

Last certification

Jun 19, 2019

Ownership / control type

For profit – corporation

Facility address

1401 8TH Street
Springer, NM 87747

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1669930392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875320158",
            "telephone_number": "505-753-7218",
            "fax_number": "505-747-7396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 8TH STREET",
            "city": "SPRINGER",
            "state": "NM",
            "postal_code": "87747",
            "telephone_number": "505-753-7218",
            "fax_number": "505-747-5946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "TYWAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "505-747-5939"
    },
    "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": "Springer SBHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gayle Ann Bustos, RN
• Francesca Chavez
• Elissa J Chazdon, P-LCSW
• Erika Derkes
• El Centro Family Health
• Stephen Evers
• First Choice Pharmacy
• Gina Marie Gamel
• Jake Gamel
• Jo Anne Jackson, M.A., C.C.C- SLP

• Federally Qualified Health Center (FQHC) in Springer, NM
• Providers in Springer, NM by specialty
• Federally Qualified Health Center (FQHC) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.