NPIMap

Organization Active NPI

Presbyterian Healthcare Services

Doing business as Socorro General Hospital

  • Critical Access Hospital
  • Socorro, NM
National Provider Identifier
1790761138
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
3014 Issued in NM
Legal business name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
Socorro General Hospital
Practice address
1202 Highway 60 West
Socorro, NM 87801-3914
Phone
(505) 835-1140
Fax
(505) 835-8716
NPI assigned
Dec 19, 2005
Last updated
Oct 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

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

Authorized official

Name
Ms. Victoria Carmignani
Title
Regulatory Compliance
Phone
(505) 923-5356

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X
Internal Medicine Physician 207R00000X
Critical Access Hospital 282NC0060X 3014 NM Primary

Addresses

Primary practice location

1202 Highway 60 West
Socorro, NM 87801-3914

Mailing address

PO Box 26666
Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5356

Other identifiers 2

IdentifierTypeStateIssuer
2255101OtherNMPART B
00695MedicaidNM

Other names 1

  • Socorro General Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000603 NM Part B Supplier - Clinic/Group Practice 9234041708 Receives reassigned benefits from 2,628 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20071227000486 NM Part A Provider - Critical Access Hospital 9234041708 Receives reassigned benefits from 216 practitioners
Practice locations: Socorro, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790761138. Details of each certification follow.

Hospital certification: CCN 321301

Legal name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
SOCORRO GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 24, 2000
Last certification
Nov 30, 2023
Beds
24
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1202 Highway 60
Socorro, NM 87801-3914
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Socorro General HospitalCCN 321301 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

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
Kimberly Poland Individual Corporate Officer Jan 1, 2011
W-2 Managing EmployeeProvider Enrollment Manager Jan 1, 2011
Nick Fleming Individual OtherBoard of Trustees Jan 1, 2016
Ron Gilworth Individual Corporate OfficerBoard Member Oct 1, 2006
Jo Anne Salome Individual OtherBoard of Trustees Jan 1, 2016
Janine Morgan Aragon Individual Corporate OfficerBoard Member Mar 1, 2008
Lynn Brandvold Individual OtherBoard of Trustees Jan 1, 1999
Eileen D Comstock Individual OtherBoard of Trustees Jan 1, 2023
Veronica Pound Individual OtherHospital Administrator Jan 1, 2016
Alan E Bassler Individual OtherBoard of Trustees Jan 1, 2011
Blake Gerard Individual OtherBoard of Trustees Jan 1, 2016
Victoria Carmignani Individual W-2 Managing Employee Apr 1, 2011
Robert Tracker Individual Corporate OfficerBoard Member Jan 1, 2010
Presbyterian Healthcare Services Organization, Socorro, NM Non-profit Operational/Managerial Control Mar 30, 2000
Lorraine Archuleta Individual Corporate OfficerBoard Member Jan 1, 2003

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Presbyterian Espanola HospitalEspanola, NM, CCN 320011 Hospital Operational/Managerial Control May 24, 1948
Plains Regional Medical Center ClovisClovis, NM, CCN 320022 Hospital Operational/Managerial Control Jan 1, 1978
Socorro General HospitalSocorro, NM, CCN 32Z301 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 321302 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 32Z302 Hospital Operational/Managerial Control Mar 15, 2000
Socorro General Hospital Home HealthcareSocorro, NM, CCN 327027 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 1, 2000
Jan 19, 2009
Plains Regional Medical Center Clovis Home HealthcareClovis, NM, CCN 327305 Home health agency 5% Or Greater Direct Ownership Interest Feb 14, 1979
Tucumcari HospiceTucumcari, NM, CCN 321566 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 1, 2009
Dec 1, 2009

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 238

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 238

Affiliated clinicians 85

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

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1790761138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-5356",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 HIGHWAY 60 WEST",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878013914",
            "telephone_number": "505-835-1140",
            "fax_number": "505-835-8716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "CARMIGNANI",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "REGULATORY COMPLIANCE",
        "authorized_official_telephone_number": "505-923-5356",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NM",
            "license": "3014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B",
            "identifier": "2255101",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00695",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Socorro General Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Socorro, NM

Sources for this page

Verify at the official NPI Registry.