Bernalillo Family Health Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

CNP-01518 Issued in NM

Legal business name

BERNALILLO FAMILY HEALTH CLINIC, LLC

Practice address

200 Oak St NE
Suite 2
Albuquerque, NM 87106-4740

Phone

(505) 508-0197

Fax

(505) 508-0465

NPI assigned

Aug 5, 2010

Organization subpart

No

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

Authorized official

Name

Jason Deluisa, CNP

Title

Owner

Phone

(505) 331-0295

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• Oak Street Clinic Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristi M. Fury, MSN CFNP

  • Family Nurse Practitioner
  • Albuquerque, NM
  • NPI 1467535658
  NPD (past)
• Kyle I Schoenberger, NP

  • Interventional Pain Medicine Physician
  • Albuquerque, NM
  • NPI 1023134863
  NPD (past)

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1801100466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25744",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871250744",
            "telephone_number": "505-508-0197",
            "fax_number": "505-508-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OAK ST NE",
            "address_2": "SUITE 2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064740",
            "telephone_number": "505-508-0197",
            "fax_number": "505-508-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERNALILLO FAMILY HEALTH CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-05",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "DELUISA",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-331-0295",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NM",
            "license": "CNP-01518",
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q7732",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21253790",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77304853",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10326855",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37805771",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bernalillo County Health Care Corporation
• Bernalillo County Tiny Home Village
• Bernalillo County Youth Services Center
• Bernalillo County Youth Services Center
• Bernalillo Family Health Clinic, LLC
• Bernalillo Health Supplies
• Jasmine Keana Bernard, LCSW, LSSW
• Jennifer Fawn Bernard, PH.D.
• Laurel B Bernard, PT, OCS, FAAOMPT
• Judith Berner, RN

• Primary Care Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Primary Care Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.