DE BACA FAMILY PRACTICE CLINIC
NPI 1003855032
Clinic/Center - Federally Qualified Health Center (FQHC) in Fort Sumner, NM
About De Baca Family Practice Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DE BACA FAMILY PRACTICE CLINIC (NPI 1003855032) is a healthcare organization registered as a federally qualified health center (fqhc) in Fort Sumner, New Mexico and active in the NPI registry since June 2006. The organization holds 2 active CLIA laboratory certificates and lists Lisa Walraven, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
De Baca Family Practice Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to De Baca Family Practice Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (5)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA 2
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 32D0863876
De Baca Family Practice Clinic Mini Lab & Sbhc · Fort Sumner, NMCertificate of Compliance 32D0537331
De Baca Family Practice Clinic · Fort Sumner, NMFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is De Baca Family Practice Clinic's NPI number?
The NPI number for De Baca Family Practice Clinic is 1003855032. It was assigned to this organization in the NPPES registry on June 5, 2006.
Where is De Baca Family Practice Clinic located?
De Baca Family Practice Clinic is located at 546 N. Tenth St, Fort Sumner, NM 88119. The listed phone number is (505) 355-2414.
What is De Baca Family Practice Clinic's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is De Baca Family Practice Clinic enrolled in Medicare?
Yes. De Baca Family Practice Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through De Baca Family Practice Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians reassign their Medicare billing to De Baca Family Practice Clinic, in Clinical Social Worker, Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does De Baca Family Practice Clinic hold CLIA laboratory certificates?
Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
When was this NPI record last updated?
The NPPES record for De Baca Family Practice Clinic was last updated on October 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# De Baca Family Practice Clinic · NPI 1003855032
Federally Qualified Health Center (FQHC) organization in Fort Sumner, New Mexico. Organization record, active in the CMS NPPES registry since June 5, 2006.
## Identity
- **NPI:** 1003855032 (Entity type: Organization)
- **Enumerated:** June 5, 2006
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Organization subpart:** No
- **Authorized official:** Lisa Walraven, CEO
## Practice location
- **Address:** 546 N. TENTH ST, Fort Sumner, NM 88119
- **Phone:** (505) 355-2414
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 5 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (2), Nurse Practitioner (2), Clinical Social Worker (1); 2 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 14, 2025
- **Other identifiers:** Other 321863 (NM)
- **CLIA laboratory certificates:** 2 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1003855032) · Data from the CMS NPPES public registry.