| Laguna Healthcare Corporation | |
|
6 Basswood Rd Paraje NM 87007 | |
| (505) 552-5664 | |
| Not Available |
| Full Name | Laguna Healthcare Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 6 Basswood Rd, Paraje, New Mexico |
| Authorized Official Name and Position | Carrie L Sarnicky (CEO) |
| Authorized Official Contact | 5055525664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laguna Healthcare Corporation Po Box 1407 Laguna NM 87026-1407 Ph: (505) 552-5664 | Laguna Healthcare Corporation 6 Basswood Rd Paraje NM 87007 Ph: (505) 552-5664 |
| NPI Number | 1962001024 |
|---|---|
| Provider Enumeration Date | 10/20/2020 |
| Last Update Date | 01/07/2021 |
| Medicare PECOS PAC ID | 2365855079 |
|---|---|
| Medicare Enrollment ID | O20210119000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962001024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 332800000X | Indian Health Service/tribal/urban Indian Health (i/t/u) Pharmacy | (* (Not Available)) | Secondary |
| Provider Name | Lori Ortiz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003902362 PECOS PAC ID: 7012950017 Enrollment ID: I20050609000645 |
| Provider Name | Timothy T Mccay |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1245221761 PECOS PAC ID: 2961456538 Enrollment ID: I20050621000935 |
| Provider Name | Dean Roy Fullingim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1770574253 PECOS PAC ID: 5193710929 Enrollment ID: I20050712000568 |
| Provider Name | Sheila Malone Taber |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447241971 PECOS PAC ID: 1557311495 Enrollment ID: I20050715000344 |
| Provider Name | Felino A Pascual |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1801877055 PECOS PAC ID: 6002801834 Enrollment ID: I20050728000628 |
| Provider Name | John S Dennis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1871584060 PECOS PAC ID: 3173594389 Enrollment ID: I20050728000739 |
| Provider Name | Myeong S Yoon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497722342 PECOS PAC ID: 0042227266 Enrollment ID: I20070219000272 |
| Provider Name | Yvonne Castaneda Delgado |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1396839783 PECOS PAC ID: 7911950621 Enrollment ID: I20080211000819 |
| Provider Name | Laura L Arrowsmith |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1083654800 PECOS PAC ID: 9638123631 Enrollment ID: I20081014000674 |
| Provider Name | Robert C Salek |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1164452207 PECOS PAC ID: 1153324454 Enrollment ID: I20081020000449 |
| Provider Name | Judith Wolfstein |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013914456 PECOS PAC ID: 0345135232 Enrollment ID: I20081203000298 |
| Provider Name | Christian Ingui |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1407893894 PECOS PAC ID: 0042213431 Enrollment ID: I20081203000324 |
| Provider Name | Ari Plosker |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639141682 PECOS PAC ID: 4587693320 Enrollment ID: I20081203000368 |
| Provider Name | Ralph Noah |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1669458741 PECOS PAC ID: 6800966284 Enrollment ID: I20090326000463 |
| Provider Name | Jeremy Scott Fullingim |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255537304 PECOS PAC ID: 5092867762 Enrollment ID: I20090917000124 |
| Provider Name | Damon L Brooks |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558583963 PECOS PAC ID: 4587715354 Enrollment ID: I20090917000269 |
| Provider Name | Michelle M Ponder |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447399415 PECOS PAC ID: 4880787217 Enrollment ID: I20100428000166 |
| Provider Name | Christos Vassiliou |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053567784 PECOS PAC ID: 8820120454 Enrollment ID: I20100719000117 |
| Provider Name | Stephen A Back |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639302060 PECOS PAC ID: 3476723594 Enrollment ID: I20110829000547 |
| Provider Name | Anthony N Fleg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538333554 PECOS PAC ID: 3375717259 Enrollment ID: I20111111000452 |
| Provider Name | Patrick B O Hayre |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518134352 PECOS PAC ID: 2264695402 Enrollment ID: I20120730000568 |
| Provider Name | Leila Danielle See |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1013164268 PECOS PAC ID: 6800059064 Enrollment ID: I20120810000291 |
| Provider Name | Jeffrey W Shelton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194864074 PECOS PAC ID: 7719141639 Enrollment ID: I20120823000396 |
| Provider Name | Jessie J Lundquist |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396064168 PECOS PAC ID: 9436300019 Enrollment ID: I20121107000348 |
| Provider Name | Carmen Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558613158 PECOS PAC ID: 8123272572 Enrollment ID: I20130212000179 |
| Provider Name | Jonathon D Kirkland |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1639315260 PECOS PAC ID: 4789823139 Enrollment ID: I20130726000027 |
| Provider Name | James N Pham |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1306089578 PECOS PAC ID: 4284876558 Enrollment ID: I20130911000061 |
| Provider Name | Alix Vincent |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003802265 PECOS PAC ID: 4789602194 Enrollment ID: I20140227000925 |
| Provider Name | Nicolaus Joseph Kuehn |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518946649 PECOS PAC ID: 6507858651 Enrollment ID: I20140228000613 |
| Provider Name | Jason Lue |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619141223 PECOS PAC ID: 2466525563 Enrollment ID: I20140303000440 |
| Provider Name | Brooke White |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1558679035 PECOS PAC ID: 4688807464 Enrollment ID: I20140516000548 |
| Provider Name | Jose Ospina |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033373287 PECOS PAC ID: 7618147653 Enrollment ID: I20140626002168 |
| Provider Name | Michael J Golden |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952527012 PECOS PAC ID: 9032353313 Enrollment ID: I20140701000579 |
| Provider Name | Nicholas Bull |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1487968756 PECOS PAC ID: 6507099389 Enrollment ID: I20140821001827 |
| Provider Name | Peter J Mostert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326346875 PECOS PAC ID: 2860635844 Enrollment ID: I20140828001578 |
| Provider Name | Anthony Morton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1922018217 PECOS PAC ID: 6608094560 Enrollment ID: I20140906000056 |
| Provider Name | Bo Yon Choi |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1053551721 PECOS PAC ID: 5890920870 Enrollment ID: I20140925002205 |
| Provider Name | Kyle G Flowers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1063710580 PECOS PAC ID: 2769703107 Enrollment ID: I20150610001387 |
| Provider Name | Donald Von Borstel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275887663 PECOS PAC ID: 3779894860 Enrollment ID: I20150617001059 |
| Provider Name | Mariana Mejia Botero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679893374 PECOS PAC ID: 7012168354 Enrollment ID: I20151022000116 |
| Provider Name | George Polanco |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1326019332 PECOS PAC ID: 0244210755 Enrollment ID: I20160713002114 |
| Provider Name | Bart M Rowlett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104945526 PECOS PAC ID: 5092602102 Enrollment ID: I20170215002368 |
| Provider Name | Kenneth E Mann |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851398713 PECOS PAC ID: 7113985441 Enrollment ID: I20170519000382 |
| Provider Name | Blake Edward Weaver |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497785893 PECOS PAC ID: 6103890975 Enrollment ID: I20170629001468 |
| Provider Name | Charles Davis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447240171 PECOS PAC ID: 9335230291 Enrollment ID: I20170825001969 |
| Provider Name | Kevin L Hamm |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1578657623 PECOS PAC ID: 8022919620 Enrollment ID: I20171014000017 |
| Provider Name | Dwight Anthony Townsend |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811981590 PECOS PAC ID: 1658279948 Enrollment ID: I20171116000698 |
| Provider Name | Craig White |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1417278573 PECOS PAC ID: 2365757481 Enrollment ID: I20180104000432 |
| Provider Name | Natalia Solomon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003173915 PECOS PAC ID: 6709141328 Enrollment ID: I20180601001555 |
| Provider Name | Aaron Wittenberg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164486338 PECOS PAC ID: 0547298036 Enrollment ID: I20180619000638 |
| Provider Name | Julia D Knarreborg |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1952662363 PECOS PAC ID: 3173828803 Enrollment ID: I20180703001304 |
| Provider Name | Laura M Young |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720048267 PECOS PAC ID: 9436109477 Enrollment ID: I20180813001041 |
| Provider Name | Alfred C Degner |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891755294 PECOS PAC ID: 4082675996 Enrollment ID: I20180822000860 |
| Provider Name | Catherine Shaeffer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811251499 PECOS PAC ID: 4385872175 Enrollment ID: I20180830000526 |
| Provider Name | Steven Matthew Wright |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1366733404 PECOS PAC ID: 0042536575 Enrollment ID: I20180912003056 |
| Provider Name | Shawn D Grant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1043214497 PECOS PAC ID: 6204877079 Enrollment ID: I20181211000646 |
| Provider Name | Marian K Ramsey Ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326579574 PECOS PAC ID: 7517243959 Enrollment ID: I20190502001215 |
| Provider Name | Eugenio Erquiaga |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1528005048 PECOS PAC ID: 6002947033 Enrollment ID: I20190923000256 |
| Provider Name | Nicholas A Strle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1851703185 PECOS PAC ID: 4587999354 Enrollment ID: I20191115001941 |
| Provider Name | Jeff Lee |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073933289 PECOS PAC ID: 2567899552 Enrollment ID: I20200304001706 |
| Provider Name | Mckinley C Lawson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1104137181 PECOS PAC ID: 6103056759 Enrollment ID: I20200609000592 |
| Provider Name | Nabil A Yassa |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1467438911 PECOS PAC ID: 8729020839 Enrollment ID: I20200609000648 |
| Provider Name | Christopher D Roman |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1033266838 PECOS PAC ID: 1850482761 Enrollment ID: I20200701000532 |
| Provider Name | David Ishimitsu |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1497919641 PECOS PAC ID: 3173783057 Enrollment ID: I20200924002219 |
| Provider Name | Jewell Ann Henley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972700888 PECOS PAC ID: 2668787334 Enrollment ID: I20201221002546 |
| Provider Name | Matthew Bledsoe |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1295116721 PECOS PAC ID: 6608188024 Enrollment ID: I20210702000599 |
| Provider Name | Rafel Alvarez |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1215383005 PECOS PAC ID: 7618247586 Enrollment ID: I20210706000944 |
| Provider Name | Tyler Braaten |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134507957 PECOS PAC ID: 3577964352 Enrollment ID: I20210708000016 |
| Provider Name | Sharon Whyte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669924585 PECOS PAC ID: 8123395100 Enrollment ID: I20210821000052 |
| Provider Name | Soumya Vempalle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1134514896 PECOS PAC ID: 9032500392 Enrollment ID: I20211220002762 |
| Provider Name | Amaya Basta |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1457589699 PECOS PAC ID: 0042434524 Enrollment ID: I20220118001954 |
| Provider Name | Dustin W Cheney |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1225492606 PECOS PAC ID: 9133523418 Enrollment ID: I20220324000946 |
| Provider Name | Aubrey Garner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689322018 PECOS PAC ID: 2264811660 Enrollment ID: I20220615000604 |
| Provider Name | Gregory Bradley |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881135804 PECOS PAC ID: 6608207824 Enrollment ID: I20221013000072 |
| Provider Name | Angela O Waller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194774190 PECOS PAC ID: 6406868892 Enrollment ID: I20230209003185 |
| Provider Name | Mehyar Hefazi Torghabeh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1548655343 PECOS PAC ID: 9830586767 Enrollment ID: I20230701000263 |
| Provider Name | Tiffany L Gethers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386301133 PECOS PAC ID: 9335526268 Enrollment ID: I20231130002239 |
| Provider Name | Nicolas William Albert Milligan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447612627 PECOS PAC ID: 1759671779 Enrollment ID: I20240123000101 |
| Provider Name | Kristie Palfreyman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477983781 PECOS PAC ID: 3971728668 Enrollment ID: I20240815000398 |
| Provider Name | Nju Akwi Endah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932439833 PECOS PAC ID: 7416370309 Enrollment ID: I20241112000026 |
| Provider Name | Adriana Romero |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043487838 PECOS PAC ID: 1658643846 Enrollment ID: I20250212000385 |
| Provider Name | Jeffrey Juchau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225083504 PECOS PAC ID: 9739084385 Enrollment ID: I20250331003363 |