NPIMap

Organization Active NPI

La Familia Medical Center

Doing business as La Familia Health

  • Federally Qualified Health Center (FQHC)
  • Santa Fe, NM
National Provider Identifier
1710049218
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
321876 Issued in NM
Legal business name
LA FAMILIA MEDICAL CENTER
Doing business as
La Familia Health
Practice address
2145 Caja del Oro Grant Rd
Santa Fe, NM 87507-3279
Phone
(505) 438-3195
Fax
(505) 982-6280
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Authorized official

Name
Brandon Vanessa Van Pelt
Title
Chief Executive Officer
Phone
(505) 982-4425

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X 321876 NM Primary

Addresses

Primary practice location

2145 Caja del Oro Grant Rd
Santa Fe, NM 87507-3279

Mailing address

2145 Caja del Oro Grant Rd
Santa Fe, NM 87507-3279
Phone (505) 982-4415

Other identifiers 1

IdentifierTypeStateIssuer
B3367MedicaidNM

Other names 1

  • La Familia Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090212000486 NM Part A Provider - Federally Qualified Health Center (FQHC) 4082601026 Practice locations: Santa Fe, NM

Federally qualified health center certification: CCN 321876

Legal name
LA FAMILIA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 30, 2000
Last certification
Jun 30, 2000
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1972 in NM
Enrollment address
2145 Caja del Oro Grant Road
Santa Fe, NM 87507-3279
Related CCNs
321804

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D0973824La Familia Medical Center Southside Clinic2145 Caja del Oro Grant Rd, Santa Fe, NM 87507Provider-performed microscopyJul 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
La Familia Medical Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Priscilla Dakin Individual Corporate DirectorBoard Chair Oct 1, 2021
Cecilia Kurzweg Individual Corporate OfficerChief Compliance Officer Jan 1, 2023
W-2 Managing EmployeeChief Compliance Officer Jan 1, 2023
Deborah Weiss Individual Corporate DirectorBoard Member, Past President Oct 1, 2023
Madelaine Leyba Individual Corporate DirectorBoard Member Oct 1, 2023
Gloria Martinez Individual Corporate DirectorBoard Vice Chair Oct 1, 2023
Mario Francis Pacheco Individual Corporate DirectorBoard Member Oct 1, 2022
Brandon Van Pelt Individual Corporate OfficerInterim Ceo Sep 29, 2023 100%
W-2 Managing Employee Sep 29, 2023 100%
Alfredo R Vigil Individual Corporate DirectorBoard Member Oct 1, 2022

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1710049218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2145 CAJA DEL ORO GRANT RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875073279",
            "telephone_number": "505-982-4415",
            "fax_number": "505-982-1263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2145 CAJA DEL ORO GRANT RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875073279",
            "telephone_number": "505-438-3195",
            "fax_number": "505-982-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA FAMILIA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "VAN PELT",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "VANESSA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "505-982-4425"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "321876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B3367",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Familia Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Fe, NM

Sources for this page

Verify at the official NPI Registry.