NPIMap

Organization Active NPI

Luminosity H&W LLC

  • Interventional Pain Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1003522798
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
LUMINOSITY H&W LLC
Practice address
6455 N Union Blvd Ste 100
Colorado Springs, CO 80918-5852
Phone
(719) 301-7246
NPI assigned
Jan 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Derek Stibbens, NPNPI 1386223394
Title
Chief Medical Officer
Phone
(719) 321-4637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

6455 N Union Blvd Ste 100
Colorado Springs, CO 80918-5852

Mailing address

6455 N Union Blvd Ste 100
Colorado Springs, CO 80918-5852
Phone (719) 301-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230510000195 CO Part B Supplier - Clinic/Group Practice 1456717883 Receives reassigned benefits from 5 practitioners
Practice locations: Colorado Springs, CO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1003522798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6455 N UNION BLVD STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809185852",
            "telephone_number": "719-301-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6455 N UNION BLVD STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809185852",
            "telephone_number": "719-301-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUMINOSITY H&W LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "STIBBENS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "719-321-4637",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.