NPIMap

Organization Active NPI

Presbyterian Medical Services

Doing business as Rio Rancho Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Rio Rancho, NM
National Provider Identifier
1871505032
Registry record updated Dec 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6613 Issued in NM
Legal business name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
Rio Rancho Family Health Center
Practice address
184 Unser Blvd
Rio Rancho, NM 87124-1058
Phone
(505) 896-0928
Fax
(505) 896-0585
NPI assigned
Aug 13, 2006
Last updated
Dec 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2007

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

Authorized official

Name
Mrs. Roberta Lee
Title
Cfo
Phone
(505) 982-5565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6613 NM Primary

Addresses

Primary practice location

184 Unser Blvd
Rio Rancho, NM 87124-1058

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
J4492MedicaidNM

Other names 1

  • Rio Rancho Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000414 NM Part B Supplier - Clinic/Group Practice 2062324684 Receives reassigned benefits from 340 practitioners
9 other NPIs on this enrollment
Practice locations: Santa Fe, NM; Socorro, NM; Rio Rancho, NM; Pecos, NM; Espanola, NM; Deming, NM; Carlsbad, NM; Albuquerque, NM…
O20101015000118 NM Part A Provider - Federally Qualified Health Center (FQHC) 2062324684 Practice locations: Rio Rancho, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871505032. Details of each certification follow.

Federally qualified health center certification: CCN 321861

Legal name
PRESBYTERIAN MEDICAL SERVICES
Doing business as
RIO RANCHO FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1996
Last certification
Jan 1, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1969 in NM
Enrollment address
184 Unser Blvd NE
Rio Rancho, NM 87124-4045

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

Other NPIs on the same Medicare enrollment 9

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

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
32D0920592PMS - Rio Rancho Family Health Center184 Unser Blvd NE, Rio Rancho, NM 87124Certificate of waiverOct 14, 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

Ownership & related parties

All disclosed owners & managing parties 20

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
Anthony Armijo Individual Corporate DirectorBoard Member Aug 22, 2011
Keith Riddle Individual Corporate DirectorBoard Member Aug 22, 2011
Steven C Hansen Individual Corporate OfficerPresident Nov 1, 2007
Michelle Maes Individual Corporate DirectorBoard Member Feb 11, 2016
Scott Michlin Individual Corporate DirectorBoard Member Aug 22, 2011
Doug Smith Individual Corporate OfficerExecutive VP & Treasurer Aug 22, 2011
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 Secre Aug 22, 2011
Patricia Collins Individual Corporate DirectorBoard Member May 2, 2014
Bryan Romkey Individual Corporate DirectorBoard Member Feb 5, 2015
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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Santa Fe Family Health CenterSante Fe, NM, CCN 321950 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 1, 2012

Practitioners & affiliated clinicians

Practitioners 353

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 353

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197504000000",
    "number": "1871505032",
    "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": "184 UNSER BLVD",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241058",
            "telephone_number": "505-896-0928",
            "fax_number": "505-896-0585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-12-13",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "505-982-5565",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NM",
            "license": "6613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "J4492",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rio Rancho Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rio Rancho, NM

Sources for this page

Verify at the official NPI Registry.