NPIMap

Organization Active NPI

Clayton Health Systems, Inc

Doing business as Des Moines Health Center

  • Family Medicine Physician
  • Des Moines, NM
National Provider Identifier
1851861587
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CLAYTON HEALTH SYSTEMS, INC
Doing business as
Des Moines Health Center
Practice address
351 Francis Avenue
Des Moines, NM 88418
Phone
(575) 278-2619
NPI assigned
Nov 26, 2018
Last updated
Sep 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CLAYTON HEALTH SYSTEMS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Authorized official

Name
Tammie Chavez
Title
Ceo
Phone
(575) 347-2585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

351 Francis Avenue
Des Moines, NM 88418

Mailing address

300 Wilson St
Clayton, NM 88415-3304

Other names 1

  • Des Moines 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
O20200218002170 NM Part A Provider - Rural Health Clinic 0941195895 Practice locations: Des Moines, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851861587. Details of each certification follow.

Rural health clinic certification: CCN 323414

Legal name
CLAYTON HEALTH SYSTEMS INC
Doing business as
UNION COUNTY GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 17, 2021
Last certification
Jun 12, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 11, 2001 in NM
Enrollment address
351 Francis Avenue
Des Moines, NM 88418
Related CCNs
321304

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

Other NPIs with the same Medicare PAC ID 4

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

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
32D2155958Des Moines Health Center351 Francis Avenue, Des Moines, NM 88418Certificate of waiverOct 8, 2026

National Provider Directory

National Provider Directory
Tax ID family
Clayton Health Systems Inc6 organizations share this tax ID, including this one
Part of
Clayton Health Systems Inc

Other organizations with this tax ID 5

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

Locations

301 Harding St
Clayton, NM 88415
Phone (505) 374-2585

314 N 3rd Ave
Clayton, NM 88415
Phone (575) 374-2273

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Clayton Health Systems Inc Organization, Clayton, NM Corporation 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Operational/Managerial Control Jan 1, 2020 100%
Terry Lancaster Individual Corporate OfficerCfo Mar 3, 2025
Dominick Diller Individual 5% Or Greater Direct Ownership Interest Jul 9, 2019 5%
Corporate OfficerBoard Vice President Jul 9, 2019 5%
Corporate DirectorBoard Vice President Jul 9, 2019 5%
Operational/Managerial ControlBoard Vice President Jul 9, 2019 5%
Craig L Reeves Individual 5% Or Greater Direct Ownership Interest Apr 1, 2018 5%
Corporate OfficerBoard Member Apr 1, 2018 5%
Corporate DirectorBoard Member Apr 1, 2018 5%
Operational/Managerial ControlBoard Member Apr 1, 2018 5%
Brian Roland Individual Corporate OfficerChief Executive Officer Feb 23, 2026
Mark E Van Wormer Individual W-2 Managing EmployeeMedical Director Apr 1, 2018 5%
Operational/Managerial ControlMedical Director Apr 1, 2018 5%
Robert Williams Individual 5% Or Greater Direct Ownership Interest Nov 27, 2017 5%
Corporate OfficerBoard Secretary Nov 27, 2017 5%
Corporate DirectorBoard Secretary Nov 27, 2017 5%
Operational/Managerial ControlBoard Secretary Nov 27, 2017 5%
Judith D Cooper Individual 5% Or Greater Direct Ownership Interest Aug 11, 2014 5%
Corporate OfficerBoard President Aug 11, 2014 5%
Corporate DirectorBoard President Aug 11, 2014 5%
Operational/Managerial ControlBoard President Aug 11, 2014 5%
Tammie U Chavez Individual Corporate OfficerCeo Sep 17, 2024 5%
W-2 Managing Employee Sep 17, 2024 5%
Operational/Managerial ControlCeo Sep 17, 2024 5%
Paul Briesh Individual 5% Or Greater Direct Ownership InterestBoard Member May 8, 2018 5%
Corporate OfficerBoard Member May 8, 2018 5%
Corporate DirectorBoard Member May 8, 2018 5%
Operational/Managerial ControlBoard Member May 8, 2018 5%

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Clayton Health Systems Inc

    dba Clayton Health Systems Medical Equipment

    • Durable Medical Equipment & Medical Supplies
    • Clayton, NM
    • NPI 1235219742

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Clayton Health Systems Inc
    • Critical Access Hospital Clinic/Center
    • Clayton, NM
    • NPI 1285715243

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Clayton Health Systems Inc

    dba Union County General Hospital

    • Critical Access Hospital
    • Clayton, NM
    • NPI 1427051002

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Clayton Health Systems, Inc

    dba Union County Health Center

    • Rural Health Clinic/Center
    • Clayton, NM
    • NPI 1265897151

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Mark Edward Van Wormer, MD
    • General Practice Physician
    • Clayton, NM
    • NPI 1013919034

    Operational/Managerial Control, W-2 Managing Employee

    CMS ownership
  • Robert W Williams, CRNA
    • Certified Registered Nurse Anesthetist
    • Springfield, TN
    • NPI 1437174521

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Union County General HospitalClayton, NM, CCN 321304 Hospital Operational/Managerial Control Sep 1, 2008
Union County General HospitalClayton, NM, CCN 32Z304 Hospital Operational/Managerial Control (100%) Sep 1, 2008
Union County Health CenterClayton, NM, CCN 323406 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 18, 2016
Oct 18, 2016

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 4

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": "1543190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1851861587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WILSON ST",
            "city": "CLAYTON",
            "state": "NM",
            "postal_code": "884153304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 FRANCIS AVENUE",
            "city": "DES MOINES",
            "state": "NM",
            "postal_code": "88418",
            "telephone_number": "575-278-2619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON HEALTH SYSTEMS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAYTON HEALTH SYSTEMS, INC",
        "enumeration_date": "2018-11-26",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "TAMMIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "575-347-2585"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Des Moines Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Des Moines, NM

Sources for this page

Verify at the official NPI Registry.