NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Ortiz Mountain Health Center

  • Federally Qualified Health Center (FQHC)
  • Cerrillos, NM
National Provider Identifier
1811064827
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6515 Issued in NM
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Ortiz Mountain Health Center
Practice address
06B Main St
Cerrillos, NM 87010
Phone
(505) 470-6266
Fax
(505) 471-5861
NPI assigned
Nov 29, 2006
Last updated
Nov 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Authorized official

Name
Roberta Lee
Title
Cfo
Phone
(505) 982-5565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6515 NM Primary
Non-Pharmacy Dispensing Site 332900000X CL00007440 NM

Addresses

Primary practice location

06B Main St
Cerrillos, NM 87010

Mailing address

PO Box 2267
Santa Fe, NM 87504-2267

Other identifiers 2

IdentifierTypeStateIssuer
F4919MedicaidNM
3209803OtherOTHER ID NUMBER

Other names 1

  • ORTIZ MOUNTAIN HEALTH CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100809000645 WI Part A Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Cerrillos, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811064827. Details of each certification follow.

Federally qualified health center certification: CCN 321859

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
ORTIZ MOUNTAIN HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
06 B Main Street
Cerrillos, NM 87010-0148

National Provider Directory

National Provider Directory
Tax ID family
PMS Dba Roundtree Childrens' Development Services70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Anne Liley Individual Corporate DirectorBoard Member Feb 11, 2016
Roberta Lee Individual Corporate DirectorBoard Member Oct 11, 2022
Steven C Hansen Individual Corporate OfficerPresident Nov 1, 2007
Mike Antiporda Individual Corporate DirectorBoard Member Jun 3, 2022
Scott Michlin Individual Corporate DirectorBoard Member Aug 22, 2011
Doug Smith Individual Corporate OfficerExecutive Vice Preident & Treasu Aug 22, 2011
Laura Jaramillo Individual Corporate DirectorBoard Member Nov 1, 2021
Marlene Waukazoo Individual Corporate DirectorBoard Member Nov 1, 2012
Don Daniel Individual Corporate OfficerCorporate Secretary May 2, 2014
W-2 Managing EmployeeCorporate Secretary May 2, 2014
Diane Lopez Individual Corporate OfficerVice President & Corporate Secre Aug 22, 2011
Bryan Romkey Individual Corporate DirectorBoard Member Feb 5, 2015
Hilda Keller Individual Corporate DirectorBoard Member Jul 1, 2022
Lillie Lewis Individual Corporate DirectorBoard Member May 2, 2013
Frank McCasland Individual Corporate DirectorBoard Member Aug 22, 2011
Melissa Sharpe Individual Corporate DirectorBoard Member Feb 5, 2015
Daniel Evans Individual Corporate DirectorBoard Member Feb 1, 2017
Susan K Smith Individual Corporate DirectorBoard Member Aug 22, 2011
Cynthia Rael-Vigil Individual Corporate DirectorBoard Member Aug 22, 2011
Kent E Mosbrucker Individual W-2 Managing EmployeeVP of Finance Aug 31, 2018

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Santa Fe Family Health CenterSante Fe, NM, CCN 321950 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 2012

Practitioners & affiliated clinicians

Practitioners 1

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": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320192000000",
    "number": "1811064827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2267",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875042267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "06B MAIN ST",
            "city": "CERRILLOS",
            "state": "NM",
            "postal_code": "87010",
            "telephone_number": "505-470-6266",
            "fax_number": "505-471-5861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2011-11-02",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "505-982-5565"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "6515",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NM",
            "license": "CL00007440",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F4919",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "3209803",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ORTIZ MOUNTAIN HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cerrillos, NM

Sources for this page

Verify at the official NPI Registry.