NPIMap

Organization Active NPI

Lutheran Hospital Association of the San Luis Valley

Doing business as San Luis Valley Health Stuart Avenue Clinic

  • Internal Medicine Physician
  • Alamosa, CO
National Provider Identifier
1972556744
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
011001 Issued in CO
Legal business name
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Doing business as
San Luis Valley Health Stuart Avenue Clinic
Practice address
2115 Stuart Ave
Alamosa, CO 81101-2269
Phone
(719) 589-3000
Fax
(719) 587-1372
NPI assigned
May 19, 2006
Last updated
Nov 24, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Authorized official

Name
Mrs. Konnie Martin
Title
C.E.O.
Phone
(719) 587-1206

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 011001 CO
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 011001 CO Primary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Preventive Medicine/Occupational Environmental Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0500X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2115 Stuart Ave
Alamosa, CO 81101-2269

Mailing address

106 Blanca Ave
Alamosa, CO 81101-2340
Phone (719) 589-3000

Other names 1

  • San Luis Valley Health Stuart Avenue Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031201000318 CO Part B Supplier - Clinic/Group Practice 4789589094 Receives reassigned benefits from 230 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alamosa, CO; Monte Vista, CO; La Jara, CO; Del Norte, CO

Other NPIs on the same Medicare enrollment 6

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
06D1033005San Luis Valley Health - Stuart Clinic2115 Stuart Ave, Alamosa, CO 81101Provider-performed microscopyJan 1, 2027

National Provider Directory

National Provider Directory
Part of
San Luis Valley Reg Med

Interoperability endpoints

  • Direct secure messaging: ecr@direct.slvrmc.org

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606176000000",
    "number": "1972556744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 BLANCA AVE",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012340",
            "telephone_number": "719-589-3000",
            "fax_number": "719-587-1372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 STUART AVE",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012269",
            "telephone_number": "719-589-3000",
            "fax_number": "719-587-1372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "KONNIE",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "719-587-1206",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "011001",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "011001",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Luis Valley Health Stuart Avenue Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Luis Valley Health Stuart Avenue Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alamosa, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.