NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Santa Fe Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Santa Fe, NM
National Provider Identifier
1851741359
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Santa Fe Family Health Center
Practice address
4730 Beckner Road
Santa Fe, NM 87507
Phone
(505) 989-4500
Fax
(505) 443-8313
NPI assigned
Jun 15, 2016
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Mr. Doug Smith
Title
Executive Vice President
Phone
(505) 982-5565

Specialties & licenses 1

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

Addresses

Primary practice location

4730 Beckner Road
Santa Fe, NM 87507

Mailing address

PO Box 2267
Santa Fe, NM 87504-2267
Phone (505) 982-5565

Other identifiers 1

IdentifierTypeStateIssuer
23856238MedicaidNM

Other names 1

  • Santa Fe Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170222001105 NM Part A Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Sante Fe, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851741359. Details of each certification follow.

Federally qualified health center certification: CCN 321950

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
SANTA FE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 9, 2017
Last certification
Mar 9, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
4730 Beckner Road
Sante Fe, NM 87507

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2284171Santa Fe Family Health Center4730 Beckner Rd, Santa Fe, NM 87507Certificate of waiverJun 19, 2027

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

Locations

4730 Beckner Rd
Santa Fe, NM 87507
Phone (505) 989-4500

Ownership & related parties

All disclosed owners & managing parties 21

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
Mario Atencio Individual Corporate DirectorBoard Member Mar 12, 2019
Presbyterian Medical Services Organization, Sante Fe, NM Corporation 5% Or Greater Direct Ownership Interest Oct 1, 2012
Roberta Lee Individual Corporate Director 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 President& 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
Diane Lopez Individual Corporate OfficerVice President& Corporate Secret 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 EmployeeVice President of Finance Aug 31, 2018

Practitioners & affiliated clinicians

Practitioners 121

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.

View all 121

NPI Registry JSON

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1851741359",
    "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",
            "telephone_number": "505-982-5565",
            "fax_number": "505-992-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 BECKNER ROAD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "87507",
            "telephone_number": "505-989-4500",
            "fax_number": "505-443-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-15",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "505-982-5565",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23856238",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Fe Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Santa Fe Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Fe, NM

Sources for this page

Verify at the official NPI Registry.