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SAN JUAN HEALTH AND WELLNESS CENTER
NPI 1568998029
Nurse Practitioner - Psychiatric/Mental Health in Farmington, NM

Active since May 03, 2017
4801 N BUTLER AVE, STE 1101, FARMINGTON, NM 87401(505) 327-0002(505) 325-9443 Get Directions Write a Review

NPPES record last updated: December 29, 2023. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Nov 13, 2023, Aug 17, 2021, Jun 29, 2021 and 1 more (4 updates tracked since 2019).

About San Juan Health And Wellness Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAN JUAN HEALTH AND WELLNESS CENTER (NPI 1568998029) is a healthcare organization registered as a psychiatric/mental health in Farmington, New Mexico and active in the NPI registry since May 2017. The organization lists Misty Dawn Diaz, Office Administrator, as its authorized official.

NPPES Registry Identity

NPI1568998029
Entity TypeOrganization
Primary Taxonomy363LP0808X
Legal Business NameSAN JUAN HEALTH AND WELLNESS CENTER
Location Address4801 N BUTLER AVE, STE 1101Farmington, NM 87401-1013
Mailing Address4801 N Butler Ave, Ste 1101Farmington, NM 87401-1013 · (505) 327-0002 · Fax (505) 325-9443
Phone(505) 327-0002
Fax(505) 325-9443
Organization SubpartNo
Authorized OfficialMisty Dawn DiazOffice Administrator · (505) 327-0002
Enumeration DateMay 3, 2017
Last NPPES UpdateDecember 29, 20234 updates tracked since enumeration
NPPES CertifiedNovember 13, 2023
✔ NPI 1568998029 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
4801 N BUTLER AVE, Farmington, NM 87401
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Other Identifiers 2

Medicaid86337556NM
Other2782NM · Last Four Of Tin

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

San Juan Health And Wellness Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to San Juan Health And Wellness Center, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Kenneth Chipman, CNP
Nurse Practitioner
NPI 1497593693
4801 N BUTLER AVE
Farmington, NM 87401
(505) 327-0002
✔ PECOS✔ Accepts Medicare0.2 mi
Eva Morales, LCSW
Clinical Social Worker
NPI 1104184019
1009 RIDGEWAY PL STE 100
Farmington, NM 87401
(505) 327-0002
✔ PECOS✔ Accepts Medicare1.1 mi
Kelly Young, RN, CNP
Nurse Practitioner
NPI 1245679000
1009 RIDGEWAY PL
Farmington, NM 87401
(505) 327-0002
✔ PECOS✔ Accepts Medicare1.1 mi
Joanna Dominick, DNP, PMHNP-BC, FNP-C
Nurse Practitioner
NPI 1174788145
72 SUTTLE ST SUITE B
Durango, CO 81303
(970) 444-2429
✔ PECOS✔ Accepts Medicare37 mi
Matthew Greenwood, APRN
Nurse Practitioner
NPI 1033680566
6001 MENAUL BLVD NE # 1002
Albuquerque, NM 87110
(505) 587-7866
✔ PECOS✔ Accepts Medicare146 mi
Thomas Mccolloch, LCSW
Clinical Social Worker
NPI 1588663322
1206 HIGHWAY 411
Vonore, TN 37885
(423) 884-7271
✔ PECOS✔ Accepts Medicare1,337 mi

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 San Juan Health And Wellness Center's NPI number?

The NPI number for San Juan Health And Wellness Center is 1568998029. It was assigned to this organization in the NPPES registry on May 3, 2017.

Where is San Juan Health And Wellness Center located?

San Juan Health And Wellness Center is located at 4801 N Butler Ave Ste 1101, Farmington, NM 87401. The listed phone number is (505) 327-0002.

What is San Juan Health And Wellness Center's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is San Juan Health And Wellness Center enrolled in Medicare?

Yes. San Juan Health And Wellness Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through San Juan Health And Wellness Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to San Juan Health And Wellness Center. 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. The largest specialties are Nurse Practitioner (4) and Clinical Social Worker (2). Of these, 3 practice 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 San Juan Health And Wellness Center was last updated on December 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.