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Picuris Medical Center

NPI 1598561318ActiveOrganization· Dentist· Penasco, NM

Dentist in Penasco, New Mexico, registered in NPPES in February 2025. The authorized official on file is Jessica Taylor Chacon, Clinical Practice Manager. Enrolled in Medicare as part b supplier - clinic/group practice.

Overview

NPI1598561318
StatusActive
Entity typeOrganization
NPI issuedFeb 21, 2025
Last updated in NPPESNov 17, 2025
Certified by providerNov 17, 2025

Specialties and licenses

TaxonomyCodeLicenseState
Dentist Primary122300000X——
Dental Hygienist124Q00000X——
Optometrist152W00000X——
Technician/Technologist, Optician156FX1800X——
Registered Nurse163W00000X——
Licensed Practical Nurse164W00000X——
Family Medicine207Q00000X——
Pediatrics208000000X——
Occupational Therapist225X00000X——
Community/Behavioral Health251S00000X——
Clinic/Center261Q00000X——
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy332800000X——
Pharmacy, Community/Retail Pharmacy3336C0003X——
Nurse Practitioner363L00000X——

About license numbers in NPPES

Exclusion screening

ListResultDetails
HHS-OIG LEIE · Oct 9, 2026No matchChecked by NPI and by name + state
North Carolina Medicaid · Nov 10, 2026No match—
New York OMIG · Nov 10, 2026No match—
Ohio Medicaid · Nov 10, 2026No match—
Pennsylvania Medicheck · Nov 10, 2026No match—
Washington HCA · Nov 10, 2026No match—

Official OIG search · How matching works ·Bulk check a roster

Medicare

Enrollment (PECOS)Enrolled Part B Supplier - Clinic/Group Practice (TX)

Medicare sources and data years

Other Dentist providers in Penasco

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