Portercare Adventist Health System
Organization Active NPI Cardiovascular Disease Physician · Glendale, CO
NPI 1003799735 · NPPES record last updated Jul 29, 2025
Key facts
- NPI
- 1003799735
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- PORTERCARE ADVENTIST HEALTH SYSTEM
- Practice address
- 425 S Cherry St Ste 410
Glendale, CO 80246-1231 - Phone
- (303) 744-1065
- Fax
- (303) 733-1699
- NPI assigned
- Jul 29, 2025
- Organization subpart
- No
Authorized official
- Name
- Jason Tacha
- Title
- Coo
- Phone
- (303) 304-7752
Corporate family (same tax ID) 12
Practitioners 1
-
Lauren Weinberg, MHS, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Avista Adventist Hospital
Locations
425 S Cherry St
Ste 410
Glendale, CO 80246
Phone (303) 333-3388
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes |
Addresses
Primary practice location
425 S Cherry St Ste 410
Glendale, CO 80246-1231
Mailing address
PO Box 713425
Chicago, IL 60677-4325
Phone (800) 953-0104
Other names
- South Denver Cardiology Cherry Creek
Other providers in Glendale, CO
- Brandon John Perticone
- Deanne Lynn Phillips
- Emily Irene Poliseo
- Judy Pomerantz
- Audrey-Carmel Porter
- Portercare Adventist Health System
- Sophia Postma
- Justin Ryan Potocki
- Antwonette Mixon Prothro
- Suzanne Purcell
All providers in Glendale, CO · Cardiovascular Disease 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 Jul 29, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.