| Pueblo Of Jemez | |
|
110 Sheep Springs Way Jemez Pueblo NM 87024 | |
| (575) 834-7413 | |
| (575) 834-7517 |
| Full Name | Pueblo Of Jemez |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 Sheep Springs Way, Jemez Pueblo, New Mexico |
| Authorized Official Name and Position | Nohemy Rosales (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 5758343187 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Of Jemez Po Box 279 Jemez Pueblo NM 87024-0279 Ph: (575) 834-7413 | Pueblo Of Jemez 110 Sheep Springs Way Jemez Pueblo NM 87024 Ph: (575) 834-7413 |
| NPI Number | 1417082215 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 02/11/2022 |
| Medicare PECOS PAC ID | 3971584509 |
|---|---|
| Medicare Enrollment ID | O20050411001246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417082215 | NPI | - | NPPES |
| 3209308 | Other | NM | NCPDP CLINIC PHARMACY |
| 79737 | Other | NM | MEDICAID CLINIC PHARMACY |
| 65337239 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | NA (New Mexico) | Primary |
| Provider Name | Diane E Alaimo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942389796 PECOS PAC ID: 5698873859 Enrollment ID: I20070612000275 |
| Provider Name | Debra L Tousley |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1962509380 PECOS PAC ID: 7416919014 Enrollment ID: I20080220000297 |
| Provider Name | Robert A Gracey |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1043202351 PECOS PAC ID: 1052476298 Enrollment ID: I20090223000193 |
| Provider Name | Joseph W Luzius |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295874287 PECOS PAC ID: 1153488598 Enrollment ID: I20090330000297 |
| Provider Name | David L Tempest |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689735540 PECOS PAC ID: 4385558915 Enrollment ID: I20101122000634 |
| Provider Name | Toby E Wilson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1124254875 PECOS PAC ID: 7416000146 Enrollment ID: I20110321000420 |
| Provider Name | Rebecca Y Bak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649565086 PECOS PAC ID: 2163650466 Enrollment ID: I20140829000249 |
| Provider Name | Mark W Osorio |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1467666248 PECOS PAC ID: 6204865660 Enrollment ID: I20141208001197 |
| Provider Name | Michael R Emery |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902990377 PECOS PAC ID: 8426954231 Enrollment ID: I20150504001088 |
| Provider Name | Yolandra G Toya |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912046939 PECOS PAC ID: 3678886918 Enrollment ID: I20150716000361 |
| Provider Name | Attlee B Benally |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1811197346 PECOS PAC ID: 4880775626 Enrollment ID: I20150825003664 |
| Provider Name | Catherine O Taylor |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568436053 PECOS PAC ID: 8729011945 Enrollment ID: I20151118002595 |
| Provider Name | Michael M Hennelly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871553933 PECOS PAC ID: 3577515808 Enrollment ID: I20151210001969 |
| Provider Name | Emily Rothman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124119698 PECOS PAC ID: 9234037086 Enrollment ID: I20171206002318 |
| Provider Name | Nora Elizabeth Lamartine |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922427624 PECOS PAC ID: 6901022243 Enrollment ID: I20180507002512 |
| Provider Name | Aprilshandiin Curley-sherer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184088627 PECOS PAC ID: 8022301977 Enrollment ID: I20191122000248 |
| Provider Name | Pamela Logan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598276644 PECOS PAC ID: 1951668763 Enrollment ID: I20191125000989 |
| Provider Name | Danielle T Chang |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1205298742 PECOS PAC ID: 7416240452 Enrollment ID: I20200213000597 |
| Provider Name | Chadd J Hiatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548881469 PECOS PAC ID: 9133541360 Enrollment ID: I20200617000690 |
| Provider Name | Leslie A Becerra |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932732351 PECOS PAC ID: 0042632960 Enrollment ID: I20201008000810 |
| Provider Name | Sharon Whyte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669924585 PECOS PAC ID: 8123395100 Enrollment ID: I20210821000052 |
| Provider Name | Julie Aste |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659718450 PECOS PAC ID: 5294073359 Enrollment ID: I20230330000014 |
| Provider Name | Louise A Crozier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649516923 PECOS PAC ID: 4789827023 Enrollment ID: I20230516000374 |
| Provider Name | Daniel P Waldman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356444939 PECOS PAC ID: 7911903117 Enrollment ID: I20230614000307 |
Jemez Valley Community Wellness Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8372 Highway 4, Jemez Pueblo, NM 87024 Phone: 505-750-3191 | |
Dba Jemez Fqhc Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 110 Sheep Springs Way, Jemez Pueblo, NM 87024 Phone: 575-834-7413 Fax: 575-834-7517 | |
Jemez Health Center Pharmacy Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 Sheepsprings Way, Jemez Pueblo, NM 87024 Phone: 575-834-0130 |