POUDRE VALLEY MEDICAL GROUP, LLC (NPI# 1942822036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942822036 |
| Entity Type | Organization |
| Organization Name | POUDRE VALLEY MEDICAL GROUP, LLC |
| Practice Address |
1750 E Ken Pratt Blvd Longmont CO 80504-5311 |
| Mailing Address |
2695 Rocky Mountain Ave Ste 150 Loveland CO 80538-9071 |
| Practice Telephone | 7207187000 |
| Practice Fax Number | 9702377848 |
| Mailing Telephone | 9702377848 |
| Mailing Fax Number | 7207187000 |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2020-05-12 |
| 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 | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| UCHealth Hospital Medicine - Longs Peak 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 |
1750 E KEN PRATT BLVD |
| City | LONGMONT |
| State | CO |
| Zip Code | 80504-5311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518954866 | Konoy Mandal | Psychiatry & Neurology | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2005-10-03 |
| 1306447180 | Poudre Valley Medical Group, LLC | Obstetrics & Gynecology | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2020-11-06 |
| 1891396990 | Alan E Benson, Md, PC | Specialist | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2020-11-04 |
| 1912506767 | Poudre Valley Medical Group, LLC | Social Worker | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2020-10-22 |
| 1538775812 | Poudre Valley Medical Group, LLC | Psychiatry & Neurology | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2020-09-22 |
| 1548880693 | Daniel Hauser | Respiratory Therapist, Registered | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2020-04-19 |
| 1487299707 | Kathryn E King | Social Worker | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2019-11-11 |
| 1225684145 | Katherine Anne Dibattisto | Social Worker | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2019-08-15 |
| 1285133819 | Emergency Physicians of The Rockies, PC | Emergency Medicine | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2018-02-09 |
| 1336675339 | Longs Peak Hospital Pharmacy | Pharmacy | 1750 E Ken Pratt Blvd, Longmont, CO 80504-5311 | 2017-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942776620 | Cinde S Yoho | Social Worker | 9485 County Road 15, Firestone, CO 80504 | 2018-10-19 |
| 1427544881 | Thousand Peaks Healthcare, Inc. | In Home Supportive Care | 310 Lashley St Ste 109, Longmont, CO 80504 | 2018-07-09 |
| 1962913962 | Melissa Frick | Counselor | 10184 E I-25 Frontage Rd, Firestone, CO 80504 | 2017-10-17 |
| 1558757260 | Firestone Pediatric Dentistry and Orthodontics | Dentist | 8301 Colorado Blvd, Suite 200, Firestone, CO 80504 | 2015-04-09 |
| 1912392671 | Ashley Lerwick | Speech-Language Pathologist | 11169 Interstate I25 Frontage Rd, Firestone, CO 80504 | 2015-03-31 |
| 1780077685 | Roger Leon Jorgensen | Ophthalmology | 14222 N 95 Si, Longmont, CO 80504 | 2015-03-17 |
| 1982942090 | Carrie Rose Fitzekam | Technician | 712 Tanagers Circle, Longmont, CO 80504 | 2013-01-24 |
| 1003166976 | Jennifer Lynn Mcnerney | Speech-Language Pathologist | 8197 Miller Dr, Frederick, CO 80504 | 2012-09-18 |
| 1821343450 | Allison Luellen | Physician Assistant | 8350 Colorado Blvd, Suite 160, Firestone, CO 80504 | 2012-07-19 |
| 1609132109 | Abby Elizabeth Bohall | Speech-Language Pathologist | 5132 Mt Buchanan Ave, Frederick, CO 80504 | 2012-04-09 |
| Find all providers in zip 80504 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891206694 | Summit Wellness Group Inc | General Practice | 7337 E County Line Rd, Longmont, CO 80504-8430 | 2017-10-19 |
| 1487800363 | Gary Fishel Gansar | General Practice | 8480 Haystack Ct, Longmont, CO 80503-7292 | 2008-08-12 |
| 1366465866 | Longmont United Hospital | General Practice | 1950 W Mountain View Ave, Longmont, CO 80501-3129 | 2006-07-25 |
| 1154937282 | Poudre Valley Medical Group, LLC | General Practice | 2900 Peak Ave, Longmont, CO 80504-6236 | 2020-09-23 |
| 1003359118 | Vcphcs X, LLC | General Practice | 850 23rd Ave, Unit A, Longmont, CO 80501-1114 | 2016-11-21 |
| 1093194755 | Joel Roberts | General Practice | 1351 Collyer St, Longmont, CO 80501 | 2015-05-27 |
| 1598932279 | Longmont United Hospital | General Practice | 1950 W Mountain View Ave, Longmont, CO 80501-3129 | 2008-05-13 |
| 1871620880 | Roberta L Shanahan | General Practice | 2345 Bent Way, Longmont, CO 80503-7614 | 2007-02-27 |
| 1669509626 | Kristi L Killgore | General Practice | 2345 Bent Way, Longmont, CO 80503-7614 | 2007-02-27 |
| 1124155130 | Melanie A Sadler | General Practice | 2345 Bent Way, Longmont, CO 80503-7614 | 2007-02-27 |
| Find all providers in LONGMONT | ||||
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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.