NPIMap

Organization Active NPI

Presbyterian Healthcare Services

  • Home Health Agency
  • Socorro, NM
National Provider Identifier
1972589307
Registry record updated Nov 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
6294 Issued in NM
Legal business name
PRESBYTERIAN HEALTHCARE SERVICES
Practice address
1202 Highway 60 Building E
Socorro, NM 87801
Phone
(575) 835-8343
Fax
(575) 835-3986
NPI assigned
Dec 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2016

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

Authorized official

Name
Victoria Carmignani
Title
Compliance
Phone
(505) 923-5356

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Home Health Agency 251E00000X 6294 NM Primary

Addresses

Primary practice location

1202 Highway 60 Building E
Socorro, NM 87801

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
N1186MedicaidNM

Other names 1

  • Socorro General Hospital Home Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090619000185 NM Part A Provider - Home Health Agency 9234041708 Practice locations: Socorro, NM

Home health agency certification: CCN 327027

Legal name
PRESBYTERIAN HEALTHCARE SERVICES
Doing business as
SOCORRO GENERAL HOSPITAL HOME HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 13, 1982
Last certification
Jan 16, 2020
Ownership / control type
Non-Profit
Organization structure
OtherNon-profit
Enrollment address
1202 Highway 60, BLDG E
Socorro, NM 87801-3914

Care Compare: Home health agency

Medicare Care Compare
Listed as
Socorro General Hospital Home Health CareCCN 327027
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
Dec 13, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Espanola Hospital Pharm69 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Ownership & related parties

All disclosed owners & managing parties 3

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 OfficerManager Provider Enrollment Jan 1, 2011
W-2 Managing EmployeeManager Provider Enrollment Jan 1, 2011
Dale Maxwell Individual Corporate Director Apr 1, 2000
Presbyterian Healthcare Services Organization, Albuquerque, NM Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2000
Operational/Managerial Control Jan 19, 2009

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 321302 Hospital Operational/Managerial Control Mar 30, 2000
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 32Z302 Hospital Operational/Managerial Control Mar 15, 2000
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

Affiliated clinicians 4

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

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": "1478563200000",
    "number": "1972589307",
    "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": "1202 HIGHWAY 60 BUILDING E",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "87801",
            "telephone_number": "575-835-8343",
            "fax_number": "575-835-3986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2016-11-08",
        "status": "A",
        "authorized_official_last_name": "CARMIGNANI",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "COMPLIANCE",
        "authorized_official_telephone_number": "505-923-5356"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NM",
            "license": "6294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N1186",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Socorro General Hospital Home Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Socorro, NM

Sources for this page

Verify at the official NPI Registry.