NPIMap

Organization Active NPI

Thoreau Clinic

  • Clinic/Center
  • Thoreau, NM
National Provider Identifier
1679516702
Registry record updated Oct 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
THOREAU CLINIC
Practice address
3 Navarre Street
Thoreau, NM 87323
Phone
(505) 862-8250
Fax
(505) 862-8909
NPI assigned
Jun 14, 2006
Last updated
Oct 18, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
DHHS PHS NAIHS CROWNPOINT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2012

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

Authorized official

Name
Mr. Anslem Roanhorse
Title
Ceo
Phone
(505) 786-5291

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3 Navarre Street
Thoreau, NM 87323

Mailing address

PO Box 358
Crownpoint, NM 87313-0358
Phone (505) 786-5291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031230000393 TX Part B Supplier - Clinic/Group Practice 0143128041 Receives reassigned benefits from 267 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Crownpoint, NM; Cuba, NM; Thoreau, NM
O20120112000511 NM Part A Provider - Hospital 0143128041 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Crownpoint, NM; Cuba, NM; Thoreau, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679516702. Details of each certification follow.

Hospital certification: CCN 320062

Legal name
DHHS PHS NAIHS CROWNPOINT HOSPITAL
Doing business as
CROWNPOINT HEALTHCARE FACILITY
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 21, 1977
Last certification
Sep 22, 2023
Beds
20
Ownership / control type
Federal
Organization structure
OtherProprietary
Incorporated
Dec 21, 1992 in NM
Enrollment address
Junction of Hwy 371 Navajo RT 9
Crownpoint, NM 87313-0358
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Crownpoint Healthcare FacilityCCN 320062 · All quality measures
Type
Acute Care Hospitals
Ownership
Government - Federal
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
DHHS PHS Naihs

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
DHHS PHS Naihs Crownpoint Hospital Organization, Crownpoint, NM Operational/Managerial Control Jul 1, 1976
Daryl Dineyazhe-Toya Individual Corporate Officer Jul 15, 2022
Corporate Director Jul 15, 2022
Orlando Johnson Individual Corporate Director Jan 30, 2023
W-2 Managing Employee Jan 30, 2023

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 266

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.

View all 266

Affiliated clinicians 46

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350518400000",
    "number": "1679516702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 358",
            "city": "CROWNPOINT",
            "state": "NM",
            "postal_code": "873130358",
            "telephone_number": "505-786-5291",
            "fax_number": "505-786-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 NAVARRE STREET",
            "city": "THOREAU",
            "state": "NM",
            "postal_code": "87323",
            "telephone_number": "505-862-8250",
            "fax_number": "505-862-8909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOREAU CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DHHS PHS NAIHS CROWNPOINT HOSPITAL",
        "enumeration_date": "2006-06-14",
        "last_updated": "2012-10-18",
        "status": "A",
        "authorized_official_last_name": "ROANHORSE",
        "authorized_official_first_name": "ANSLEM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-786-5291",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thoreau, NM

Sources for this page

Verify at the official NPI Registry.