PEDIATRIX MEDICAL GROUP OF COLORADO, P.C. (NPI# 1174137806) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174137806 |
| Entity Type | Organization |
| Organization Name | PEDIATRIX MEDICAL GROUP OF COLORADO, P.C. |
| Practice Address |
400 W 16th St Pueblo CO 81003-2745 |
| Mailing Address |
4722 N 24th St Ste 150 Phoenix AZ 85016-4860 |
| Practice Telephone | 7195844000 |
| Mailing Telephone | 8777374546 |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |
| Authorized Official Name | DR. RICHARD PORRECO (PRESIDENT) |
| Authorized Official Telephone | 9543840175 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 9000145481 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754175 | Pediatrix Medical Group of Colorado, P.C. | Pediatrics | 4050 Briargate Pkwy, Colorado Springs, CO 80920-7815 | 2020-09-09 |
| 1558975284 | Pediatrix Medical Group of Colorado, P.C. | Pediatrics | 4090 Briargate Pkwy, Colorado Springs, CO 80920-7815 | 2020-09-01 |
| 1164656120 | Pediatrix Medical Group of Colorado, P.C. | Pediatrics | 1400 E Boulder St, Colorado Springs, CO 80909-5533 | 2009-05-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | PEDIATRIX MEDICAL GROUP OF COLORADO, P.C. | 1301 Concord Terrace, Sunrise, FL 33323 |
| Street Address |
400 W 16TH ST |
| City | PUEBLO |
| State | CO |
| Zip Code | 81003-2745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992700694 | James E Caldwell | Anesthesiology | 400 W 16th St, Pueblo, CO 81003-2745 | 2005-06-17 |
| 1992327217 | Kristina Reavis | Nurse Practitioner | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-05-08 |
| 1881214567 | Nathan S Grigg | Student in an Organized Health Care Education/Training Program | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-04-22 |
| 1467083881 | Erik Matthews Wickstrum | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-02-04 |
| 1497385082 | Sean Jastillano | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-01-22 |
| 1417597287 | Zainab Adeyemo | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-01-09 |
| 1265071658 | Victoria Louise Farnsworth | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-01-02 |
| 1205479557 | Brandis Courtney Montez | Nurse Practitioner | 400 W 16th St, Pueblo, CO 81003-2781 | 2019-10-18 |
| 1750923199 | Catholic Health Initiatives Colorado | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 400 W 16th St, Pueblo, CO 81003-2745 | 2019-10-16 |
| 1154963130 | Parkview Ancillary Services | Hospitalist | 400 W 16th St, Pueblo, CO 81003-2745 | 2019-10-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164042016 | Sunil Kumar | Student in an Organized Health Care Education/Training Program | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2020-04-21 |
| 1497382303 | Pueblo Family Dentistry Pllc | Dentist | 701 N Grand Avenue, Suite B, Pueblo, CO 81003 | 2020-03-23 |
| 1023654241 | Elmer A. Villalon, Dmd, LLC | Clinic/Center | 1225 North Main Street, #207, Pueblo, CO 81003 | 2019-11-22 |
| 1518434349 | Mariam Rahim | Internal Medicine | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-10-30 |
| 1003308222 | Julia Mcneice | Internal Medicine | Parkview Medial Center, Parkveiw Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-06-04 |
| 1689164857 | Jessica Sels | Internal Medicine | Parkview Medical Center Adult Medicine Clinic, 311 W 14th St, Pueblo, CO 81003 | 2018-05-14 |
| 1700313459 | Allison Vigil | Occupational Therapist | 1600 W. 24th St, Pueblo, CO 81003 | 2017-05-12 |
| 1245682020 | Paul S Bongat | Internal Medicine | 411 W. 14th St., Parkview Adult Medicine Clinic, Pueblo, CO 81003 | 2016-07-06 |
| 1013368596 | Daniel R Long | Internal Medicine | 411 West 14th Street, Pueblo, CO 81003 | 2016-06-27 |
| 1396195665 | Parkview Medical Center | General Acute Care Hospital | 411 W. 14th St, Pueblo, CO 81003 | 2016-06-17 |
| Find all providers in zip 81003 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487254215 | Sheridan Childrens Healthcare Services of Colorado PC | Pediatrics | 340 Peak Oned Drive, Frisco, CO 80443 | 2020-10-30 |
| 1679891832 | Tristan Poe Lindberg | Pediatrics | 6001 E Woodmen Road, Colorado Springs, CO 80923 | 2010-05-12 |
| 1770668402 | Bonita Carson | Pediatrics | 4191 S Colorado Blvd, Englewood, CO 80113-5039 | 2006-10-25 |
| 1518041953 | Karen Marie Zarlengo | Pediatrics | 1601 E 19th Ave Ste 5300, Denver, CO 80218-1229 | 2006-10-24 |
| 1497709646 | Pamela Jean Gewinner | Pediatrics | 1165 Pennsylvania St, Denver, CO 80203-2501 | 2006-05-20 |
| 1386600260 | Michael S Paranka | Pediatrics | 1601 E. 19th Street, Suite 5300, Denver, CO 80218 | 2006-04-21 |
| 1962465807 | Glenn Mark Shoptaugh | Pediatrics | 82 Raven Hills Ct, Colorado Springs, CO 80919-1316 | 2006-04-11 |
| 1942263173 | David Arnold Belenky | Pediatrics | 1713 E Lake Dr, Centennial, CO 80121-2607 | 2006-04-10 |
| 1669479705 | Kathleen Sue Bohanon | Pediatrics | 4090 Stonebridge Pt, Colorado Springs, CO 80904-4704 | 2005-07-05 |
| 1649870957 | Sheridan Childrens Healthcare Services of Colorado PC | Pediatrics | 14300 Orchard Pkwy, Westminster, CO 80023-9206 | 2020-10-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.