NPIMap

Organization Active NPI

El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Espanola, NM
National Provider Identifier
1821373812
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
711 Bond St.
Espanola, NM 87532-2729
Phone
(505) 753-9503
Fax
(505) 747-1004
NPI assigned
Oct 21, 2011
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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 NU Primary

Addresses

Primary practice location

711 Bond St.
Espanola, NM 87532-2729

Mailing address

PO Box 158
538 N Paseo de Onate
Espanola, NM 87532-0158
Phone (505) 753-7218

Other identifiers 2

IdentifierTypeStateIssuer
118395554MedicaidNM
1780689034OtherNMORGANIZATION NPPES

Other names 1

  • El Centro Family Health Bond Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090113000917 NM Part A Provider - Federally Qualified Health Center (FQHC) 9830080688 1 other NPI on this enrollment
Practice locations: Espanola, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821373812. Details of each certification follow.

Federally qualified health center certification: CCN 321879

Legal name
EL CENTRO FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 4, 2000
Last certification
Aug 4, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1972 in NM
Enrollment address
711 Bond St
Espanola, NM 87532-2729
Related CCNs
321836

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

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Health CTRS of Northern10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the 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
Ryan Baca Individual Corporate DirectorBoard Member Oct 29, 2014
Rosalie Lopez Individual Corporate DirectorBoard Member May 28, 2014
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
Gary Reece Individual Corporate DirectorBoard Member Mar 26, 2014
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
Lucille Montoya Individual W-2 Managing EmployeeChief Operations Manager Dec 8, 1975
Sinforosa Lovato Individual Corporate DirectorBoard Member Feb 1, 1995
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 10

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": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1821373812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "address_2": "538 N PASEO DE ONATE",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875320158",
            "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": "711 BOND ST.",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322729",
            "telephone_number": "505-753-9503",
            "fax_number": "505-747-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-21",
        "last_updated": "2014-11-25",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118395554",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION NPPES",
            "identifier": "1780689034",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Family Health Bond Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Espanola, NM

Sources for this page

Verify at the official NPI Registry.