San Miguel Clinic Corp - Medicare Primary Care in Las Vegas, NM

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San Miguel Clinic Corp is a medicare enrolled primary clinic (Family Medicine) in Las Vegas, New Mexico. The current practice location for San Miguel Clinic Corp is 108 Legion Dr Ste A, Las Vegas, New Mexico. For appointments, you can reach them via phone at (505) 454-9499. The mailing address for San Miguel Clinic Corp is Po Box 5009, Brentwood, Tennessee and phone number is () -.

San Miguel Clinic Corp is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1114920717. 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) 454-9499.

Contact Information

San Miguel Clinic Corp
108 Legion Dr Ste A
Las Vegas
NM 87701-4898
(505) 454-9499
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameSan Miguel Clinic Corp
SpecialityFamily Medicine
Location108 Legion Dr Ste A, Las Vegas, New Mexico
Authorized Official Name and PositionLaura J Fey (DIRECTOR REVENUE CYCLE)
Authorized Official Contact6152213641
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
San Miguel Clinic Corp
Po Box 5009
Brentwood
TN 37024-5009

Ph: () -		San Miguel Clinic Corp
108 Legion Dr Ste A
Las Vegas
NM 87701-4898

Ph: (505) 454-9499

NPI Details:

NPI Number1114920717
Provider Enumeration Date05/27/2005
Last Update Date10/17/2023

Medicare PECOS Information:

Medicare PECOS PAC ID1254226079
Medicare Enrollment IDO20040219000384

Medical Identifiers

Medical identifiers for San Miguel Clinic Corp such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1114920717NPI-NPPES
47485817MedicaidNM

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine (* (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. San Miguel Clinic Corp acts as a billing entity for following providers:
Provider NameWietske Moore
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1235291394
PECOS PAC ID: 9638073760
Enrollment ID: I20031120000990
Provider NameLoutsios K Ierides
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1578601753
PECOS PAC ID: 8224092705
Enrollment ID: I20041115000794
Provider NameMichael E Gurule
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1447398623
PECOS PAC ID: 0244215606
Enrollment ID: I20041115000823
Provider NameRaymond F Ortiz
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1497708754
PECOS PAC ID: 8325086408
Enrollment ID: I20050419001420
Provider NameJessica L Roberts
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1821078270
PECOS PAC ID: 0446285175
Enrollment ID: I20051025000281
Provider NameRobin M Edward
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1538193818
PECOS PAC ID: 2769499516
Enrollment ID: I20060320000388
Provider NameFranklin Miller
Provider TypePractitioner - Pulmonary Disease
Provider IdentifiersNPI Number: 1659375194
PECOS PAC ID: 6204908346
Enrollment ID: I20080707000071
Provider NameAyodele O Erinle
Provider TypePractitioner - Nephrology
Provider IdentifiersNPI Number: 1235183492
PECOS PAC ID: 1951313584
Enrollment ID: I20081216000256
Provider NameAnne C Kessler
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1801855309
PECOS PAC ID: 5193861706
Enrollment ID: I20100324001032
Provider NameRoderick D Woods
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1306929633
PECOS PAC ID: 7416846647
Enrollment ID: I20101222001017
Provider NameLaura A Allen
Provider TypePractitioner - Addiction Medicine
Provider IdentifiersNPI Number: 1144314519
PECOS PAC ID: 6800050725
Enrollment ID: I20120605000622
Provider NameChenthuran Deivaraju
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1477832517
PECOS PAC ID: 3274853098
Enrollment ID: I20150519001745
Provider NameJennifer Achilles
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1891965133
PECOS PAC ID: 4587738091
Enrollment ID: I20150910002334
Provider NameMehul U Daulat
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1508270745
PECOS PAC ID: 2466671276
Enrollment ID: I20171002001882
Provider NameTracy Wilkerson
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1952517732
PECOS PAC ID: 2062605710
Enrollment ID: I20180531001186
Provider NameNanette S Nuessle
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1184630741
PECOS PAC ID: 7618008244
Enrollment ID: I20180719001514
Provider NameMorgan E Schopen
Provider TypePractitioner - Certified Nurse Midwife (cnm)
Provider IdentifiersNPI Number: 1548542954
PECOS PAC ID: 5799957940
Enrollment ID: I20180723001045
Provider NameRyan Victor Villegas
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1780029215
PECOS PAC ID: 2163790270
Enrollment ID: I20180814001369
Provider NameTeddi Leah Denienne Swidinsky
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1578090296
PECOS PAC ID: 2264708445
Enrollment ID: I20181114003126
Provider NameMaria De Las Mercedes Sayago De Aramburu
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1225251184
PECOS PAC ID: 9537317979
Enrollment ID: I20181227000726
Provider NameTrina C Parker
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1316191950
PECOS PAC ID: 8123144219
Enrollment ID: I20190315001382
Provider NameMelissa Goodrich
Provider TypePractitioner - Certified Nurse Midwife (cnm)
Provider IdentifiersNPI Number: 1245746098
PECOS PAC ID: 9931534781
Enrollment ID: I20200124000403
Provider NameKofi Turkson
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1538101142
PECOS PAC ID: 1850292970
Enrollment ID: I20200204002285
Provider NameErika Michelle Green
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1750043204
PECOS PAC ID: 2365890480
Enrollment ID: I20231130001816

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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.