Portercare Adventist Health System

Organization Active NPI Family Medicine Physician · Elizabeth, CO

NPI 1003446485 · NPPES record last updated Aug 14, 2026

Key facts

NPI
1003446485
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
PORTERCARE ADVENTIST HEALTH SYSTEM
Practice address
240 Elizabeth St Ste B
Elizabeth, CO 80107-7546
Phone
(303) 269-2551
Fax
(303) 269-2552
NPI assigned
Jan 24, 2020
Organization subpart
No

Authorized official

Name
Mr. Jason Tacha
Title
Coo
Phone
(303) 304-7752

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090115000327 CO Part B Supplier - Clinic/Group Practice 0941110886 Receives reassigned benefits from 869 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Locations

240 S Elizabeth St
Ste B
Elizabeth, CO 80107
Phone (303) 269-2551

240 S Elizabeth St
Elizabeth, CO 80107
Phone (303) 646-3757

240 S Elizabeth St
Unit 103
Elizabeth, CO 80107
Phone (262) 989-6647

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207Q00000X Yes

Addresses

Primary practice location

240 Elizabeth St Ste B
Elizabeth, CO 80107-7546

Mailing address

PO Box 713425
Chicago, IL 60677-4325
Phone (800) 953-0104

Other names

  • AdventHealth Medical Group Primary Care at Elizabeth Doing business as
  • Centura Medical Group Primary Care Elizabeth Other name

Other providers in Elizabeth, CO

All providers in Elizabeth, CO · Family Medicine Physician in Colorado

Sources for this page

Verify at the official NPI Registry.