San Juan Regional Medical Center Inc
Organization Active NPI Family Medicine Physician · Aztec, NM
NPI 1861467433 · NPPES record last updated Jul 16, 2025
Key facts
- NPI
- 1861467433
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SAN JUAN REGIONAL MEDICAL CENTER INC
- Practice address
- 120 Llano St
Aztec, NM 87410 - Phone
- (505) 334-3404
- Fax
- (505) 334-3486
- NPI assigned
- Feb 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Kim Byrd
- Title
- Administrative Director of Reimburs
- Phone
- (505) 609-2588
Other NPIs on the same Medicare enrollment 18
Member organizations 1
Practitioners 82
-
Christen Marie Janney, NP-C
-
Karen A Lecomte, M.D.
-
Miki R Moffitt, RN, BSN, FNP-C
-
Tara Colleen Smith, C.N.P.
-
Joseph C Szekely, MD
-
June A. Kwark, M.D.
-
Jacob Alexander, DO, MPH
-
Roberto Reble Bamba Jr., M.D.
-
Stephen Thomas Bernard, M.D.
-
James M Boyd, MD
-
Erika M Campos, C-FNP
-
Dominic Michael Cannella, M.D.
-
Jessica A Conklin, CNP
-
Paul Francis Davis, M.D.
-
Laberta Dempsey, CNP
-
Tejwant Singh Dhillon, M.D.
-
Mark Allen Fisher, M.D.
-
Candace Esther Flores, APRN-CNP
-
Shawna M Frost, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D2012763 | San Juan Health Partners Aztec | Provider-performed microscopy | Sep 8, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040218000865 | NM | Part B Supplier - Clinic/Group Practice | 4587559505 |
Receives reassigned benefits from 396 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Farmington, NM; Bloomfield, NM; Aztec, NM |
National Provider Directory
Locations
2300 E 30th St
Ste B-102
Farmington, NM 87401
Phone (505) 327-4044
610 W Pinon St
#610
Farmington, NM 87401
Phone (505) 325-1123
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Cardiovascular Disease Physician |
207RC0000X | |||
| Physical Medicine & Rehabilitation Physician |
208100000X | |||
| Psychiatry Physician |
2084P0800X | |||
| Urology Physician |
208800000X | |||
| Obstetrics & Gynecology Nurse Practitioner |
363LX0001X |
Addresses
Primary practice location
120 Llano St
Aztec, NM 87410
Mailing address
PO Box 844088
Dallas, TX 75284-4088
Phone (505) 609-2258
Other practice location 1
102 Llano St
Aztec, NM 87410-2172
Phone (505) 334-9441
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000B7708 | Medicaid | NM |
Other names
- SJRMC Aztec Clinic
- San Juan Health Partners Family Medicine
Other providers in Aztec, NM
- Patricia Rosenberger
- Rutledge Skin Care Clinic, PA
- Safeway Inc
- Jerika Salazar
- Sylvia Salzer
- Alicia Marie Sanchez
- Kathleen Mary Sansing
- Julie Raquel Schaffer
- Leah M Schlierf
- Michael B Sells
All providers in Aztec, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.