POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1760081509) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760081509 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
11820 Destination Dr Broomfield CO 80021-2518 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 3034606068 |
| Practice Fax Number | 7207180925 |
| Mailing Telephone | 3034606068 |
| Mailing Fax Number | 7207180925 |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2020-10-22 |
| Authorized Official Name | JANA CONROY (CREDENTIALING MANAGER) |
| Authorized Official Telephone | 9706244443 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| (LCSW)UCHealth Emergency Care - Broomfield Hospital | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350476 | Poudre Valley Medical Group, LLC | Urology | 2315 E Harmony Rd Ste 140, Fort Collins, CO 80528-8620 | 2020-09-15 |
| 1699389353 | Poudre Valley Medical Group, LLC | Internal Medicine | 5818 N Nevada Ave, Suite 225, Colorado Springs, CO 80918 | 2020-09-01 |
| 1700490455 | Poudre Valley Medical Group, LLC | Radiology | 4080 Briargate Parkway, Colorado Springs, CO 80920 | 2020-09-01 |
| 1134732209 | Poudre Valley Medical Group, LLC | Physical Medicine & Rehabilitation | 5818 N Nevada Avenue, Suite 225, Colorado Springs, CO 80918 | 2020-08-28 |
| 1104439322 | Poudre Valley Medical Group, LLC | Radiology | 525 Bob Peters Grv Ste 100, Colorado Springs, CO 80909-4533 | 2020-08-27 |
| 1932712155 | Poudre Valley Medical Group, LLC | Internal Medicine | 940 Central Park Dr Ste 290, Steamboat Springs, CO 80487-8853 | 2020-08-27 |
| 1033722376 | Poudre Valley Medical Group, LLC | Family Medicine | 15854 Jackson Creek Pkwy Unit 120, Monument, CO 80132-8663 | 2020-08-26 |
| 1285247866 | Poudre Valley Medical Group, LLC | Physical Therapist | 6767 29th St Fl 1, Greeley, CO 80634-5474 | 2020-08-25 |
| 1932711868 | Poudre Valley Medical Group, LLC | Obstetrics & Gynecology | 100 Cook St Ste 210, Denver, CO 80206-5328 | 2020-08-21 |
| 1619586187 | Poudre Valley Medical Group, LLC | Urology | 175 S Union Blvd Ste 315, Colorado Springs, CO 80910-3126 | 2020-07-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Poudre Valley Medical Group, LLC | 2695 Rocky Mountain Ave., Suite 110, Loveland, CO 80538 |
| Street Address |
11820 DESTINATION DR |
| City | BROOMFIELD |
| State | CO |
| Zip Code | 80021-2518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760481519 | Tammron Jay Kleeman | Orthopaedic Surgery | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2005-07-14 |
| 1851998967 | Sikora Elizabeth Cain | Physician Assistant | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2020-10-02 |
| 1821555863 | Ellyn Ann Ayervais | Physician Assistant | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2019-02-26 |
| 1770048217 | Uchealth Broomfield Hospital | Rehabilitation Unit | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2019-02-08 |
| 1326503475 | Ana Janette Ehrlich | Spec/Tech, Pathology | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2019-02-03 |
| 1891297651 | Uchealth Emergency Physician Services PC | Clinic/Center | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2018-03-07 |
| 1245754910 | Moranda Lynn Boles | Dietitian, Registered | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2017-08-03 |
| 1093165268 | Jordan Matthew Wyrwa | Physical Medicine & Rehabilitation | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2016-06-17 |
| 1730539214 | Catherine Grant Cooper | Physical Medicine & Rehabilitation | 11820 Destination Dr, Broomfield, CO 80021-2518 | 2016-06-15 |
| 1528442357 | Uchealth Broomfield Hospital | Rehabilitation Unit | 11820 Destination Dr, Broomfield, CO 80021 | 2015-07-10 |
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|---|---|---|---|---|
| 1851941934 | Denver Restorative Dentistry Pllc | Dentist | 8181 Arista Place, Suite 140, Broomfield, CO 80021 | 2019-09-19 |
| 1205490398 | Amber Kay Kisser | Occupational Therapist | 7770 W 101st Ave, Westminster, CO 80021 | 2019-04-24 |
| 1871093138 | Samantha Ewing | Audiologist | 403 Summit Blvd., # 204, Broomfield, CO 80021 | 2018-02-13 |
| 1568978914 | Denver Recovery Center, LLC | Clinic/Center | 295 Interlocken Blvd Ste 400, Broomfield, CO 80021 | 2017-12-21 |
| 1730601477 | Elaine H Kim | Audiologist | 120 Edgeview Dr., Unit 6220, Broomfield, CO 80021 | 2017-07-14 |
| 1245605575 | Profound Fitness, LLC | Day Training, Developmentally Disabled Services | 7721 W 92nd Ave, Westminster, CO 80021 | 2015-12-11 |
| 1558785634 | Nichelle Francavilla Gurule | Chiropractor | 11336 W 104th Ave, Westminster, CO 80021 | 2014-02-10 |
| 1255770244 | Martha Ha | Dentist | 645 Flatiron Marketplace Dr Unit A, Broomfield, CO 80021 | 2013-06-23 |
| 1467737841 | Nathaniel Weidner | Pharmacist | 10350 Dover St. D28, Westminster, CO 80021 | 2011-10-17 |
| 1346475209 | Christine Marie Maren | Family Medicine | 8181 Arista Pl Unit 100, Broomfield, CO 80021 | 2009-05-21 |
| Find all providers in zip 80021 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274880 | Tana Dell | Social Worker | 12160 Deerfield Way, Broomfield, CO 80020-5390 | 2020-08-03 |
| 1821624594 | Kelley Stephenson | Social Worker | 469 Co-7, Broomfield, CO 80023 | 2020-03-13 |
| 1770146680 | Thaddeus Frye | Social Worker | 1008 Depot Hill Rd # 201, Broomfield, CO 80020-6723 | 2019-04-16 |
| 1144759101 | Aimee Suzanne Tulou | Social Worker | 1020 Lilac St, Broomfield, CO 80020-1041 | 2017-06-05 |
| 1932577004 | Meredith Villiers | Social Worker | 5686 Brook Hollow Dr, Broomfield, CO 80020-3932 | 2015-09-08 |
| 1144600461 | Bethany Frakes | Social Worker | 1140 Bellaire St, Broomfield, CO 80020-1439 | 2015-06-02 |
| 1215004791 | Lynda Carole Arnold | Social Worker | 700 Burbank St, Broomfield, CO 80020-1658 | 2006-11-29 |
| 1457459794 | Diana Shenkin | Social Worker | 710 Burbank St Ste F, Broomfield, CO 80020-1658 | 2006-09-20 |
| 1548294515 | Andrea Coral Devita | Social Worker | 12886 W Montane Cir, Broomfield, CO 80021-2815 | 2006-07-10 |
| 1194375055 | Discover Peace Within, LLC | Social Worker | 6363 W 120th Ave Ste 310, Broomfield, CO 80020-2406 | 2019-09-12 |
| Find all providers in BROOMFIELD | ||||
| City | BROOMFIELD |
| Zip Code | 80021 |
Please comment or provide details below to improve the information on POUDRE VALLEY MEDICAL GROUP, LLC.
| 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.