NPIMap

Organization Active NPI

Clinica Campesina Family Health Services

Doing business as Clinica Family Health & Wellness

  • Federally Qualified Health Center (FQHC)
  • Lafayette, CO
National Provider Identifier
1831186915
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0556 Issued in CO
Legal business name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Doing business as
Clinica Family Health & Wellness
Practice address
1735 S Public Rd Ste 100
Lafayette, CO 80026-7093
Phone
(303) 665-9310
Fax
(303) 926-0363
NPI assigned
Oct 4, 2005
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Brian J Johnston
Title
Cfo
Phone
(303) 926-0625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0556 CO Primary

Addresses

Primary practice location

1735 S Public Rd Ste 100
Lafayette, CO 80026-7093

Mailing address

1735 S Public Rd Ste 203
Lafayette, CO 80026-7093
Phone (303) 665-3036

Other identifiers 1

IdentifierTypeStateIssuer
05638259MedicaidCO

Other names 1

  • Clinica Family Health & Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031106000276 CO Part B Supplier - Clinic/Group Practice 7315850484 Receives reassigned benefits from 246 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Broomfield, CO; Longmont, CO; Lafayette, CO; Boulder, CO
O20040929000131 CO Part A Provider - Federally Qualified Health Center (FQHC) 7315850484 Practice locations: Lafayette, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831186915. Details of each certification follow.

Federally qualified health center certification: CCN 061803

Legal name
CLINICA CAMPESINA FAMILY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1992
Last certification
Oct 1, 1992
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1977 in CO
Enrollment address
1735 S Public Rd
Ste 100
Lafayette, CO 80026-7093

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Clinica Campesina Fam H27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

1735 S Public Rd
Ste 100
Lafayette, CO 80026
Phone (303) 665-2962

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
Inez D Buggs Individual Corporate OfficerBoard Member Oct 1, 2009
Jeff Zayach Individual Corporate Officer Aug 1, 2021
Carolina Flores Manross Individual Corporate Officer Aug 1, 2020
Douglas Jones Individual Corporate Officer Sep 1, 2011
Ella Padilla Individual Corporate Officer Sep 1, 2018
Matthew Antush Individual Corporate Officer Jul 1, 2019
Heather Elkins Individual Corporate Officer Oct 1, 2009
Brian Johnston Individual Corporate OfficerCfo Dec 2, 2022
Corporate DirectorCfo Dec 2, 2022
Cherlyn a Marriott Individual Corporate OfficerBoard Member Sep 1, 2011
Lizandro Gonzalez Individual Corporate Officer Aug 1, 2020
Edson Hernandez Individual Corporate Officer Oct 1, 2017
Mayra Martinez Individual Corporate Officer Aug 1, 2016
Heidy Ordonez Individual Corporate Officer Sep 1, 2017
Simon G Smith Individual Corporate OfficerCeo Oct 1, 2013
W-2 Managing EmployeeCeo Oct 1, 2013

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Clinica Family HealthNederland, CO, CCN 061033 Federally qualified health center Other Jun 1, 2022
Clinica Family Health ServicesBlack Hawk, CO, CCN 061034 Federally qualified health center Other Jun 1, 2022

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1831186915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD STE 203",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093",
            "telephone_number": "303-665-3036",
            "fax_number": "303-665-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD STE 100",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093",
            "telephone_number": "303-665-9310",
            "fax_number": "303-926-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA CAMPESINA FAMILY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-926-0625"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": "0556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638259",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinica Family Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, CO

Sources for this page

Verify at the official NPI Registry.