NPIMap

Organization Active NPI

El Centro Family Health

  • Federally Qualified Health Center (FQHC)
  • Las Vegas, NM
National Provider Identifier
1902208234
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EL CENTRO FAMILY HEALTH
Practice address
1236 5TH St
Las Vegas, NM 87701-4337
Phone
(505) 454-2737
NPI assigned
Sep 18, 2014
Last updated
Jun 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Authorized official

Name
Mrs. Lore Pease
Title
Ceo
Phone
(505) 753-7218

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 3393 NM
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1236 5TH St
Las Vegas, NM 87701-4337

Mailing address

538 N Paseo de Onate
P.O. Box 158
Espanola, NM 87532-2618
Phone (505) 753-7218

Other identifiers 1

IdentifierTypeStateIssuer
1780689034OtherNMNPPES

Other names 1

  • El Centro Family Health RHS SBHC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170531000888 NM Part A Provider - Federally Qualified Health Center (FQHC) 9830080688 Practice locations: Las Vegas, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902208234. Details of each certification follow.

Federally qualified health center certification: CCN 321952

Legal name
EL CENTRO FAMILY HEALTH
Doing business as
ROBERTSON HIGH SCHOOL BASED CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 30, 2017
Last certification
May 30, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 6, 1975 in NM
Enrollment address
1236 5TH St
Las Vegas, NM 87701-4337

Other NPIs with the same Medicare PAC ID 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Health CTRS of Northern10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1236 5th St
Las Vegas, NM 87701
Phone (505) 429-2548

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Paul a Guiles Individual Corporate DirectorBoard Member Aug 1, 2008
Sylvia a Vigil Individual Corporate DirectorBoard Member Jan 1, 2013
Evaristo Maestas Individual Corporate DirectorBoard Member Mar 1, 2009
David Muniz Individual Corporate DirectorBoard Member Sep 29, 2016
Nesha Morse Individual Corporate DirectorBoard Member Dec 1, 2013
Lebeo Martinez Individual Corporate DirectorBoard Member Nov 1, 1994
Luis a Trivino Individual W-2 Managing EmployeeCoo Aug 3, 2015
Linette Deane Individual Corporate DirectorBoard Member Nov 28, 2016
Richard C Frey Individual Corporate DirectorBoard Member Oct 1, 2008
Pearl Maestas Individual Corporate DirectorBoard Member Nov 1, 2011
Francine Kain Individual Corporate OfficerAuthorized Official Oct 10, 2011
Juliet Garcia-Gonzales Individual Corporate DirectorBoard Member Aug 26, 2015
Jackie Feeler Individual Corporate DirectorBoard Member Feb 1, 2013
Janette Archuleta Individual Corporate DirectorBoard Member Mar 1, 2012
El Centro Family Health Organization, Espanola, NM Non-profit Operational/Managerial Control Sep 7, 2016

Owners & managing parties with NPI records 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 3

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": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1902208234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 N PASEO DE ONATE",
            "address_2": "P.O. BOX 158",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322618",
            "telephone_number": "505-753-7218",
            "fax_number": "505-753-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 5TH ST",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014337",
            "telephone_number": "505-454-2737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "PEASE",
        "authorized_official_first_name": "LORE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-753-7218",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NM",
            "license": "3393",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1780689034",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "El Centro Family Health RHS SBHC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "El Centro Family Health RHS SBHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Las Vegas, NM

Sources for this page

Verify at the official NPI Registry.