DE BACA FAMILY PRACTICE CLINIC
NPI 1114737483
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 1114737483), doing business as De Baca Family Practice Clinic/mobile Unit, is a healthcare organization registered as a federally qualified health center (fqhc) in Fort Sumner, New Mexico and active in the NPI registry since January 2025. The organization lists Lisa Walraven, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 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.
Frequently 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 1114737483. It was assigned to this organization in the NPPES registry on January 9, 2025. The provider is doing business as De Baca Family Practice Clinic/Mobile Unit.
Where is De Baca Family Practice Clinic located?
De Baca Family Practice Clinic is located at 546 N 10th Street, Fort Sumner, NM 88119. The listed phone number is (575) 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.
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 1114737483
Federally Qualified Health Center (FQHC) organization in Fort Sumner, New Mexico. Organization record, active in the CMS NPPES registry since January 9, 2025.
## Identity
- **NPI:** 1114737483 (Entity type: Organization)
- **Enumerated:** January 9, 2025
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Also known as:** De Baca Family Practice Clinic/Mobile Unit (Doing Business As)
- **Organization subpart:** Yes (part of De Baca Family Practice Clinic)
- **Authorized official:** Lisa Walraven, CEO
## Practice location
- **Address:** 546 N 10TH STREET, Fort Sumner, NM 88119
- **Phone:** (575) 355-2414 · **Fax:** (575) 355-7894
## 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
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Source: [NPI Profile](https://npiprofile.com/npi/1114737483) · Data from the CMS NPPES public registry.