| |
455 Saint Michaels Dr Santa Fe NM 87505-7601 | |
(505) 982-4425 | |
(505) 982-6280 |
Full Name | |
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Speciality | Clinic/Center |
Location | 455 Saint Michaels Dr, Santa Fe, New Mexico |
Authorized Official Name and Position | Julie Kay Wright (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5059824425 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1035 Alto St Santa Fe NM 87501-2406 Ph: (505) 982-4425 | 455 Saint Michaels Dr Santa Fe NM 87505-7601 Ph: (505) 982-4425 |
NPI Number | 1811059322 |
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Provider Enumeration Date | 12/14/2006 |
Last Update Date | 06/09/2023 |
Medicare PECOS PAC ID | 4082601026 |
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Medicare Enrollment ID | O20040429001343 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811059322 | NPI | - | NPPES |
Z1678 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New Mexico) | Primary |
Provider Name | Janeen D Maas |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1174534044 PECOS PAC ID: 6507755444 Enrollment ID: I20040310001563 |
Provider Name | Ronald Press |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1841365731 PECOS PAC ID: 0042208316 Enrollment ID: I20040505000090 |
Provider Name | Gary E Giblin |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1396733283 PECOS PAC ID: 4486636826 Enrollment ID: I20040601001084 |
Provider Name | Melissa S Rosen |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609848118 PECOS PAC ID: 1456335793 Enrollment ID: I20040615001127 |
Provider Name | Erika L Benson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104814193 PECOS PAC ID: 9032162912 Enrollment ID: I20050502000825 |
Provider Name | Maria E Mcmahon |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073574067 PECOS PAC ID: 3274549381 Enrollment ID: I20060303000561 |
Provider Name | Jonathan D Beamer |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1578511218 PECOS PAC ID: 3678579539 Enrollment ID: I20061017000209 |
Provider Name | Sue Katz |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1669460580 PECOS PAC ID: 0547458267 Enrollment ID: I20101222000602 |
Provider Name | Laura M Mccann |
---|---|
Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1700162344 PECOS PAC ID: 5597931253 Enrollment ID: I20111229000576 |
Provider Name | Matthew J Schmidt |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1538391719 PECOS PAC ID: 5193974723 Enrollment ID: I20120925000730 |
Provider Name | Mary H Roessel |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1194900340 PECOS PAC ID: 2163662677 Enrollment ID: I20130705000248 |
Provider Name | Kristina Louise Sinnott |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023321437 PECOS PAC ID: 1254503758 Enrollment ID: I20141121002105 |
Provider Name | Susan F Griggs |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245641836 PECOS PAC ID: 6305161837 Enrollment ID: I20150204001363 |
Provider Name | Lauren E Waltersdorf |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1295091007 PECOS PAC ID: 2769783000 Enrollment ID: I20151210002097 |
Provider Name | Kimberly Lopez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1588106363 PECOS PAC ID: 3375826340 Enrollment ID: I20170217000497 |
Provider Name | Mervianna M Thompson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811185333 PECOS PAC ID: 1557317278 Enrollment ID: I20171017000297 |
Provider Name | Emma Goodstein |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1407389471 PECOS PAC ID: 8325303571 Enrollment ID: I20200911000462 |
Provider Name | Juan C Deoses Burciaga |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1144731761 PECOS PAC ID: 0345670899 Enrollment ID: I20201111000077 |
Provider Name | Jaleh M Akhavan |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1043743008 PECOS PAC ID: 9133490899 Enrollment ID: I20201120000737 |
Provider Name | Adrienne A Martinez |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023661683 PECOS PAC ID: 3678904463 Enrollment ID: I20210604000612 |
Provider Name | Kim Nguyen |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1588920268 PECOS PAC ID: 2860772217 Enrollment ID: I20220216002824 |
Provider Name | Rachel Pradarelli |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942809256 PECOS PAC ID: 7911319371 Enrollment ID: I20220328000469 |
Provider Name | Morgan Alexandra Smith |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558094649 PECOS PAC ID: 0143601914 Enrollment ID: I20220726000473 |
Provider Name | Kathryn Doster |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891358644 PECOS PAC ID: 6204212772 Enrollment ID: I20221006001642 |
Provider Name | Kate Nelson |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1679208052 PECOS PAC ID: 0648646638 Enrollment ID: I20221017000588 |
Provider Name | Elizabeth Holland |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1689663536 PECOS PAC ID: 3779931746 Enrollment ID: I20231201000229 |
Provider Name | Paula Summar |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1376986620 PECOS PAC ID: 9335582873 Enrollment ID: I20240212002305 |
Provider Name | Marie O Hennelly |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912393539 PECOS PAC ID: 0042526410 Enrollment ID: I20240216002139 |
Provider Name | Bagambhrini Thompkins |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1851885628 PECOS PAC ID: 6406254523 Enrollment ID: I20240718002953 |
Provider Name | Carlos I Martinez |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1144809609 PECOS PAC ID: 3678010402 Enrollment ID: I20240730000974 |
Provider Name | Silvia Santiago Morales |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1194303081 PECOS PAC ID: 2769914449 Enrollment ID: I20241018002607 |
Provider Name | Claudia Cruz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740037258 PECOS PAC ID: 0840723961 Enrollment ID: I20241029000716 |
Provider Name | Tyler D Sams |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1780213546 PECOS PAC ID: 3678902806 Enrollment ID: I20241107001127 |
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