NPIMap

Organization Active NPI

Northern New Mexico Health Care, LLC

  • Specialist
  • Espanola, NM
National Provider Identifier
1861535825
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NORTHERN NEW MEXICO HEALTH CARE, LLC
Practice address
18648 Hwy 84-285
#C
Espanola, NM 87532
Phone
(505) 753-7576
Fax
(505) 753-7676
NPI assigned
Feb 15, 2007
Last updated
Jun 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

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

Authorized official

Name
Mr. Jonathan Karl Frederiksen
Title
President-Owner
Phone
(505) 757-6666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

18648 Hwy 84-285
#C
Espanola, NM 87532

Mailing address

1421 Luisa St Ste R
Santa Fe, NM 87505-4073
Phone (505) 753-7576

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070504000265 NM Part B Supplier - Clinic/Group Practice 4880790088 Receives reassigned benefits from 2 practitioners
Practice locations: Espanola, NM; Santa Fe, NM

National Provider Directory

National Provider Directory
Tax ID family
Health Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1421 Luisa St
Ste R
Santa Fe, NM 87505
Phone (505) 470-6119

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782086400000",
    "number": "1861535825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 LUISA ST STE R",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875054073",
            "telephone_number": "505-753-7576",
            "fax_number": "505-753-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18648 HWY 84-285",
            "address_2": "#C",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "87532",
            "telephone_number": "505-753-7576",
            "fax_number": "505-753-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN NEW MEXICO HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A",
        "authorized_official_last_name": "FREDERIKSEN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "KARL",
        "authorized_official_title_or_position": "PRESIDENT-OWNER",
        "authorized_official_telephone_number": "505-757-6666",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Espanola, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.