NPIMap

Organization Active NPI

Presbyterian Healthcare Services

Doing business as Dr Dan C Trigg Memorial Hospital

  • Critical Access Hospital
  • Tucumcari, NM
National Provider Identifier
1962488304
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
3011 Issued in NM
Legal business name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
Dr Dan C Trigg Memorial Hospital
Practice address
301 E Miel de Luna Ave
Tucumcari, NM 88401-3810
Phone
(505) 461-0141
Fax
(505) 461-1822
NPI assigned
Dec 19, 2005
Last updated
Apr 7, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Authorized official

Name
Mr. Dale Maxwell
Title
Cfo
Phone
(505) 923-5353

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X
Internal Medicine Physician 207R00000X
Critical Access Hospital 282NC0060X 3011 NM Primary

Addresses

Primary practice location

301 E Miel de Luna Ave
Tucumcari, NM 88401-3810

Mailing address

PO Box 26666
Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-5356

Other identifiers 2

IdentifierTypeStateIssuer
00265MedicaidNM
2255606OtherNMPART B

Other names 1

  • Dr Dan C Trigg Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000603 NM Part B Supplier - Clinic/Group Practice 9234041708 Receives reassigned benefits from 2,628 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20090305000373 NM Part A Provider - Critical Access Hospital 9234041708 Receives reassigned benefits from 135 practitioners
Practice locations: Tucumcari, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962488304. Details of each certification follow.

Hospital certification: CCN 321302

Legal name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
DR. DAN C. TRIGG MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Mar 15, 2000
Last certification
Jan 19, 2022
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Incorporated
in NM
Enrollment address
301 E Miel de Luna
Dr. Dan C. Trigg Memorial Hospital
Tucumcari, NM 88401-3810
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Dr Dan C Trigg Memorial HospitalCCN 321302 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

201 Cedar St SE
Ste 7600
Albuquerque, NM 87106
Phone (505) 563-2500

8312 Kaseman Ct NE
Albuquerque, NM 87110
Phone (505) 291-2200

301 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-7000

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Kimberly Poland Individual Corporate Officer Jan 1, 2011
W-2 Managing EmployeeManager Provider Enrollment Jan 1, 2011
Brad Bryant Individual OtherBoard of Trustees Jan 1, 2016
Yvonne Braziel Individual OtherBoard of Trustees Jan 1, 2016
Lou Briscoe Individual OtherBoard of Trustees Jan 1, 2016
Will Cantrell Individual OtherBoard of Trustees Jan 1, 2016
Lynda Cain Individual OtherBoard of Trustees Jan 1, 2016
Craig Cosner Individual OtherBoard of Trustees Jan 1, 2016
Darrell Willis Individual OtherBoard of Trustees Jan 1, 2016
Steven Figge Individual Corporate DirectorDirector of Mso Jan 1, 2010
W-2 Managing EmployeeDirector of Mso Jan 1, 2010
Troy Clark Individual W-2 Managing EmployeeVP, RDS Hospital Operations Jan 1, 2017
OtherVP, RDS Hospital Operations Jan 1, 2017
Thomas Sidwell Individual OtherBoard of Trustees Jan 1, 2016
Presbyterian Healthcare Services Organization, Tucumcari, NM Non-profit Operational/Managerial Control Mar 30, 2000
Mary Elizabeth Sisneros Individual OtherBoard of Trustees Jan 1, 2016

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Presbyterian Espanola HospitalEspanola, NM, CCN 320011 Hospital Operational/Managerial Control May 24, 1948
Plains Regional Medical Center ClovisClovis, NM, CCN 320022 Hospital Operational/Managerial Control Jan 1, 1978
Socorro General HospitalSocorro, NM, CCN 32Z301 Hospital Operational/Managerial Control Mar 30, 2000
Socorro General HospitalSocorro, NM, CCN 321301 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 32Z302 Hospital Operational/Managerial Control Mar 15, 2000
Socorro General Hospital Home HealthcareSocorro, NM, CCN 327027 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 1, 2000
Jan 19, 2009
Plains Regional Medical Center Clovis Home HealthcareClovis, NM, CCN 327305 Home health agency 5% Or Greater Direct Ownership Interest Feb 14, 1979
Tucumcari HospiceTucumcari, NM, CCN 321566 Hospice 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Dec 1, 2009
Dec 1, 2009

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 160

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 160

Affiliated clinicians 50

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1962488304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-5356",
            "fax_number": "505-923-5354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E MIEL DE LUNA AVE",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884013810",
            "telephone_number": "505-461-0141",
            "fax_number": "505-461-1822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "505-923-5353",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NM",
            "license": "3011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00265",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B",
            "identifier": "2255606",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Dan C Trigg Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucumcari, NM

Sources for this page

Verify at the official NPI Registry.