De Baca Family Practice Clinic - Medicare Primary Care in Fort Sumner, NM

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De Baca Family Practice Clinic is a medicare enrolled primary clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Fort Sumner, New Mexico. The current practice location for De Baca Family Practice Clinic is 546 N. Tenth St, Fort Sumner, New Mexico. For appointments, you can reach them via phone at (505) 355-2414. The mailing address for De Baca Family Practice Clinic is Po Box 349, Fort Sumner, New Mexico and phone number is () -.

De Baca Family Practice Clinic is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1003855032. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (505) 355-2414.

Contact Information

De Baca Family Practice Clinic
546 N. Tenth St
Fort Sumner
NM 88119
(505) 355-2414
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameDe Baca Family Practice Clinic
SpecialityClinic/Center
Location546 N. Tenth St, Fort Sumner, New Mexico
Authorized Official Name and PositionLisa Walraven (CEO)
Authorized Official Contact5753552414
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
De Baca Family Practice Clinic
Po Box 349
Fort Sumner
NM 88119-0349

Ph: () -		De Baca Family Practice Clinic
546 N. Tenth St
Fort Sumner
NM 88119

Ph: (505) 355-2414

NPI Details:

NPI Number1003855032
Provider Enumeration Date06/05/2006
Last Update Date02/19/2019

Medicare PECOS Information:

Medicare PECOS PAC ID6406758358
Medicare Enrollment IDO20040122000409

Medical Identifiers

Medical identifiers for De Baca Family Practice Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1003855032NPI-NPPES
321863OtherNMNGS ID

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QF0400XClinic/center - Federally Qualified Health Center (fqhc) (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. De Baca Family Practice Clinic acts as a billing entity for following providers:
Provider NameJack D Vick
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1538242219
PECOS PAC ID: 1254233695
Enrollment ID: I20040124000417
Provider NameEdna Gail Gutierrez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1376536854
PECOS PAC ID: 7113829060
Enrollment ID: I20050328001095
Provider NameLaney M Pierce
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1679966451
PECOS PAC ID: 8921300328
Enrollment ID: I20160524001059
Provider NameJames Gonzales
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1730507955
PECOS PAC ID: 3476850116
Enrollment ID: I20170405002161
Provider NameShantell Moyers
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1598270399
PECOS PAC ID: 8729348347
Enrollment ID: I20180130002016
Provider NameCandace Michele Kernell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1770133746
PECOS PAC ID: 5294067773
Enrollment ID: I20240612003459

Reviews and Comments


Clinic/Center in Fort Sumner, NM

De Baca Family Practice Clinic/school Site
Primary Care Clinic
Medicare: Medicare Enrolled
Practice Location: 1001 Sumner Ave, Fort Sumner, NM 88119
Phone: 575-355-4431    Fax: 575-355-4432

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.