Intermountain Medical Group Denver, LLC
Organization Active NPI Neurological Surgery Physician · Lafayette, CO
NPI 1003514639 · NPPES record last updated Jun 28, 2024
Key facts
- NPI
- 1003514639
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurological Surgery Physician 207T00000X
- Legal business name
- INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
- Practice address
- 340 Exempla Cir Ste 300
Lafayette, CO 80026-3384 - Phone
- (303) 673-1390
- Fax
- (720) 627-6407
- NPI assigned
- Feb 22, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- INTERMOUNTAIN FRONT RANGE, INC.
Authorized official
- Name
- Jon McDaniel
- Title
- VP Finance
- Phone
- (303) 272-0231
Corporate family (same tax ID) 12
Practitioners 14
-
Brian Joseph Allen, M.D.
-
Trey Patrick-Skylar Conroy, PT, DPT
-
Sourabh Goyal, DO
-
Christa Fair Hackney, LCSW
-
Brianna Whittemore, M.D.
-
Kevin David Heinrich, PT, DPT
-
Rishi Kundi, M.D.
-
Lindsey McAlonan, PT, DPT
-
Liana Gwynn Miley, LPC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D2300667 | Lafayette Clinic - Neurosurgery | Certificate of waiver | Mar 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150106000131 | CO | Part B Supplier - Clinic/Group Practice | 0840513552 |
Receives reassigned benefits from 1,361 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Intermountain Medical Group Denver LLC
- Part of
- Lutheran Medical Center
Locations
16570 Washington St
Thornton, CO 80023
Phone (303) 498-1885
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician |
207T00000X | Yes | ||
| Neurology Physician |
2084N0400X |
Addresses
Primary practice location
340 Exempla Cir Ste 300
Lafayette, CO 80026-3384
Mailing address
500 Eldorado Blvd Ste 4300
Broomfield, CO 80021-3564
Phone (303) 272-0566
Other names
- Lafayette Clinic - Orthopedic Spine
- Lafayette Clinic Neurosurgery
Other providers in Lafayette, CO
- Integrated Opiate Compliance Corp
- Integrated Rehab Consultants Colorado LLC
- Integrated Sports & Spine LLC
- Interim Healthcare of Greater Denver Inc
- Intermountain Front Range, Inc.
- Intermountain Medical Group Denver, LLC
- Intermountain Medical Group Denver, LLC
- Intermountain Medical Group Denver, LLC
- Intermountain Medical Group Denver, LLC
- Intermountain Medical Group Denver, LLC
All providers in Lafayette, CO · Neurological Surgery Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.