| Santo Domingo Health Center | |
|
85 W Highway 22 Santo Domingo Pueblo NM 87052-0559 | |
| (505) 465-3060 | |
| (505) 465-1191 |
| Full Name | Santo Domingo Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 85 W Highway 22, Santo Domingo Pueblo, New Mexico |
| Authorized Official Name and Position | Jimmie R Charlie (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 5054653060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santo Domingo Health Center Po Box 559 Santo Domingo Pueblo NM 87052-0559 Ph: (505) 465-3060 | Santo Domingo Health Center 85 W Highway 22 Santo Domingo Pueblo NM 87052-0559 Ph: (505) 465-3060 |
| NPI Number | 1467739888 |
|---|---|
| Provider Enumeration Date | 11/14/2011 |
| Last Update Date | 02/22/2024 |
| Medicare PECOS PAC ID | 7618137779 |
|---|---|
| Medicare Enrollment ID | O20120327000617 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467739888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 03217726007 (New Mexico) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Bernadette Dayzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245393032 PECOS PAC ID: 2062318421 Enrollment ID: I20031208001043 |
| Provider Name | Eduardo A Alas |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1932200904 PECOS PAC ID: 4587664107 Enrollment ID: I20070105000049 |
| Provider Name | Diane E Alaimo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942389796 PECOS PAC ID: 5698873859 Enrollment ID: I20070612000275 |
| Provider Name | Faith C Shapiro |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1528128352 PECOS PAC ID: 0840374914 Enrollment ID: I20080227000746 |
| Provider Name | Brenda J Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992747018 PECOS PAC ID: 1951480714 Enrollment ID: I20080505000525 |
| Provider Name | Bruce E Onofrey |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1639102130 PECOS PAC ID: 3870500671 Enrollment ID: I20090226000161 |
| Provider Name | Joseph W Luzius |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295874287 PECOS PAC ID: 1153488598 Enrollment ID: I20090330000297 |
| Provider Name | Mathew A Strickland |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1588841845 PECOS PAC ID: 7810041050 Enrollment ID: I20090821000419 |
| Provider Name | Jimmie R Charlie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366523722 PECOS PAC ID: 7911047543 Enrollment ID: I20091211000706 |
| Provider Name | Lani M Desaulniers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174510028 PECOS PAC ID: 7113106147 Enrollment ID: I20110124000645 |
| Provider Name | Toby E Wilson |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1124254875 PECOS PAC ID: 7416000146 Enrollment ID: I20110321000420 |
| Provider Name | Elizabeth B Cumby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962591669 PECOS PAC ID: 4587565403 Enrollment ID: I20120315000808 |
| Provider Name | Stephanie J Mahooty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922399542 PECOS PAC ID: 1052598950 Enrollment ID: I20140207000334 |
| Provider Name | Asit Bhatt |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1184839854 PECOS PAC ID: 0244320604 Enrollment ID: I20151023000293 |
| Provider Name | Linda L Garcia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467508077 PECOS PAC ID: 8527247782 Enrollment ID: I20160127000939 |
| Provider Name | Stacia Jacobi-garcia |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1376609636 PECOS PAC ID: 1456323534 Enrollment ID: I20170113000244 |
| Provider Name | Anthony Willert |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1417313826 PECOS PAC ID: 7113201740 Enrollment ID: I20170228000351 |
| Provider Name | Shan Shan Chen |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1487945507 PECOS PAC ID: 6103135587 Enrollment ID: I20170607000324 |
| Provider Name | Diana Marie Valdez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093804114 PECOS PAC ID: 1759673023 Enrollment ID: I20170607002657 |
| Provider Name | Gail Norton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336568252 PECOS PAC ID: 8022235845 Enrollment ID: I20170922000946 |
| Provider Name | Patricia D Morrow |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851465397 PECOS PAC ID: 3274670054 Enrollment ID: I20171108001822 |
| Provider Name | Emily Rothman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124119698 PECOS PAC ID: 9234037086 Enrollment ID: I20171206002318 |
| Provider Name | Jessica M Monthan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851683411 PECOS PAC ID: 2365683612 Enrollment ID: I20180111000136 |
| Provider Name | Howard Waitzkin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770598245 PECOS PAC ID: 4587752084 Enrollment ID: I20180220000981 |
| Provider Name | Johannah R Yazzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164941621 PECOS PAC ID: 5597026476 Enrollment ID: I20180312000761 |
| Provider Name | James D Lutz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194714741 PECOS PAC ID: 8123001393 Enrollment ID: I20180314000671 |
| Provider Name | Mary Thalia Kelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659427938 PECOS PAC ID: 3971730813 Enrollment ID: I20180316000548 |
| Provider Name | Liana Ponce |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881851343 PECOS PAC ID: 6204082316 Enrollment ID: I20180327000212 |
| Provider Name | Marcie Lichtenstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538532312 PECOS PAC ID: 3678870698 Enrollment ID: I20190731002848 |
| Provider Name | Ronald Press |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841365731 PECOS PAC ID: 0042208316 Enrollment ID: I20191018000918 |
| Provider Name | Steven Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265886683 PECOS PAC ID: 1759674690 Enrollment ID: I20191125000143 |
| Provider Name | Ronda Ramsier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740334192 PECOS PAC ID: 9133225469 Enrollment ID: I20200131000031 |
| Provider Name | Carrie Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437448404 PECOS PAC ID: 9032352927 Enrollment ID: I20200212000698 |
| Provider Name | Minhnga Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295992576 PECOS PAC ID: 2264605229 Enrollment ID: I20200615001079 |
| Provider Name | Sarah Lauren Friedberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790149607 PECOS PAC ID: 9830484799 Enrollment ID: I20200617002291 |
| Provider Name | Deborah Berest |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801396585 PECOS PAC ID: 0941564363 Enrollment ID: I20201022001833 |
| Provider Name | Brian Goff Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881951366 PECOS PAC ID: 0749414852 Enrollment ID: I20201106000580 |
| Provider Name | Alexandra Emilia Gada |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1124689336 PECOS PAC ID: 0244567006 Enrollment ID: I20201208001790 |
| Provider Name | Angela Xaviera Torres |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1750615506 PECOS PAC ID: 7517370760 Enrollment ID: I20210106002365 |
| Provider Name | Dennis W. Jackson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1881999761 PECOS PAC ID: 6305247602 Enrollment ID: I20210624000400 |
| Provider Name | Robert M Bernstein |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1467460840 PECOS PAC ID: 9739155979 Enrollment ID: I20211130000504 |
| Provider Name | Annie Rabinovitch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942794870 PECOS PAC ID: 9739567017 Enrollment ID: I20220526002334 |
| Provider Name | Jessie Mae Simmon |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558715003 PECOS PAC ID: 8123443983 Enrollment ID: I20221004003333 |
| Provider Name | Joseph Williams |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760469498 PECOS PAC ID: 0446645337 Enrollment ID: I20230527000342 |
| Provider Name | Teriann Chavez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407922818 PECOS PAC ID: 1052656261 Enrollment ID: I20230830001665 |
| Provider Name | Carmen Salazar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104591148 PECOS PAC ID: 8022406198 Enrollment ID: I20231010004003 |