NPIMap

Organization Active NPI

Ben Archer Health Center

  • Federally Qualified Health Center (FQHC)
  • Radium Springs, NM
National Provider Identifier
1770734865
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BEN ARCHER HEALTH CENTER
Practice address
12080 LB Lindbeck Rd
Radium Springs, NM 88054-0419
Phone
(575) 267-3280
Fax
(575) 267-1747
NPI assigned
Oct 7, 2008
Last updated
Oct 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Mary Alice Garay
Title
Executive Director
Phone
(575) 267-3280

Specialties & licenses 1

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

Addresses

Primary practice location

12080 LB Lindbeck Rd
Radium Springs, NM 88054-0419

Mailing address

PO Box 370
Hatch, NM 87937-0370
Phone (575) 267-3280

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031120000966 NM Part B Supplier - Clinic/Group Practice 7517878796 Receives reassigned benefits from 92 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Truth Or Consequences, NM; Radium Springs, NM; Deming, NM; Las Cruces, NM; Columbus, NM; Hatch, NM; Alamogordo, NM
O20081023000585 NM Part A Provider - Federally Qualified Health Center (FQHC) 7517878796 Practice locations: Radium Springs, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770734865. Details of each certification follow.

Federally qualified health center certification: CCN 321906

Legal name
BEN ARCHER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 29, 2009
Last certification
Jan 29, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1973 in NM
Enrollment address
12080 L B Lindbeck Rd
Radium Springs, NM 88054

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Ben Archer Health Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

12080 Lindbeck Rd
Las Cruces, NM 88007

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Christina Fierro Individual Corporate Director Oct 3, 2008
Vicente Zamora Individual Corporate Director Feb 1, 2021
Mary Alice Garay Individual Corporate DirectorExecutive Director Oct 3, 2008
W-2 Managing Employee Oct 3, 2008
Sylvia McGuire Individual Corporate Director Feb 1, 2021
Shawna Runyan Individual Corporate Director Feb 1, 2021
Bobby Cordero Individual Corporate Director Feb 1, 2021
Patricia Leyba Individual Corporate Director Oct 3, 2008
Elwin Roach Individual Corporate Director Oct 3, 2008
Ryan Jaramillo Individual Corporate Director Feb 1, 2021

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1770734865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "HATCH",
            "state": "NM",
            "postal_code": "879370370",
            "telephone_number": "575-267-3280",
            "fax_number": "575-267-1747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12080 LB LINDBECK RD",
            "city": "RADIUM SPRINGS",
            "state": "NM",
            "postal_code": "880540419",
            "telephone_number": "575-267-3280",
            "fax_number": "575-267-1747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEN ARCHER HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-07",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "GARAY",
        "authorized_official_first_name": "MARY ALICE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "575-267-3280"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Radium Springs, NM

Sources for this page

Verify at the official NPI Registry.