NPIMap

Organization Active NPI

El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Penasco, NM
National Provider Identifier
1790940716
Registry record updated May 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6102 Issued in NM
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
State Road 75 #15136
Penasco, NM 87553-2627
Phone
(575) 587-2205
Fax
(575) 587-1944
NPI assigned
Jul 21, 2008
Last updated
May 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2015

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

Authorized official

Name
Mrs. Lore Pease
Title
Ceo
Phone
(505) 753-7218

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6102 NM Primary

Addresses

Primary practice location

State Road 75 #15136
Penasco, NM 87553-2627

Mailing address

538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218

Other identifiers 2

IdentifierTypeStateIssuer
1780689034OtherNMORGANIZATION NPPES
47092MedicaidNM

Other names 1

  • El Centro Family Health Penasco Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090113000834 NM Part A Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Penasco, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790940716. Details of each certification follow.

Federally qualified health center certification: CCN 321831

Legal name
EL CENTRO FAMILY HEALTH
Doing business as
PENASCO MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1972 in NM
Enrollment address
15136 State Road 75
Penasco, NM 87553-0238

Other NPIs with the same Medicare PAC ID 18

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

View all 18

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Paul a Guiles Individual Corporate DirectorBoard Member Aug 1, 2008
Sylvia a Vigil Individual Corporate DirectorBoard Member Jan 1, 2013
Evaristo Maestas Individual Corporate DirectorBoard Member Mar 1, 2009
Nesha Morse Individual Corporate DirectorBoard Member Dec 1, 2013
Rebecca Valdez Individual Corporate Director May 1, 2018
Lore Pease Individual Corporate OfficerCeo Jun 6, 2007
Lebeo Martinez Individual Corporate DirectorBoard Member Nov 1, 1994
Richard C Frey Individual Corporate DirectorBoard Member Oct 1, 2008
Mardoqueo Chacon Individual Corporate DirectorBoard Member Dec 1, 2004
Pearl Maestas Individual Corporate DirectorBoard Member Nov 1, 2011
Francine Kain Individual Corporate OfficerCfo Oct 10, 2011
Lynsey Wheeler Individual Corporate DirectorBoard Member Aug 1, 2012
Jerome Williams Individual Corporate Officer Dec 20, 2017
Lucille Montoya Individual W-2 Managing EmployeeCoo Jan 1, 2002
Sinforosa Lovato Individual Corporate DirectorBoard Member Feb 1, 1985
Jackie Feeler Individual Corporate DirectorBoard Member Feb 1, 2013
Janette Archuleta Individual Corporate DirectorBoard Member Mar 1, 2012

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Robertson High School Based ClinicLas Vegas, NM, CCN 321952 Federally qualified health center Operational/Managerial Control Sep 7, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1790940716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N PASEO DE ONATE",
            "address_2": "P.O. BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322618",
            "telephone_number": "505-753-7218",
            "fax_number": "505-753-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STATE ROAD 75 #15136",
            "city": "PENASCO",
            "state": "NM",
            "postal_code": "875532627",
            "telephone_number": "575-587-2205",
            "fax_number": "575-587-1944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-21",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "PEASE",
        "authorized_official_first_name": "LORE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-753-7218",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "6102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION NPPES",
            "identifier": "1780689034",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47092",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Family Health Penasco Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Penasco, NM

Sources for this page

Verify at the official NPI Registry.