Individual provider Active NPI

Coral Breanne Martinez

  • Gerontology Nurse Practitioner
  • Pueblo, CO
National Provider Identifier
1013486299
Registry record updated Nov 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APN.0994299-NP Issued in CO
Practice address
1600 N Grand Ave Ste 150
Pueblo, CO 81003-2755
Phone
(719) 595-7680
NPI assigned
Nov 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APN.0994299-NP CO Primary

Addresses

Primary practice location

1600 N Grand Ave Ste 150
Pueblo, CO 81003-2755

Mailing address

1600 N Grand Ave Ste 150
Pueblo, CO 81003-2755
Phone (719) 595-7680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181231001464 CO Practitioner - Nurse Practitioner 3870838444 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Signify Health Medical Associates, PLLC Nurse Practitioner CurrentSince Feb 1, 2026 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

7700 E Arapahoe Rd
Ste 220
Centennial, CO 80112
Phone (303) 285-1148

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

405 W 15th St
Ste 210
Pueblo, CO 81003
Phone (719) 584-7300

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

1600 N Grand Ave
Ste 150
Pueblo, CO 81003
Phone (719) 595-7680

405 W 15th St
Pueblo, CO 81003
Phone (719) 545-0663

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1542412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542412800000",
    "number": "1013486299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N GRAND AVE STE 150",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032755",
            "telephone_number": "719-595-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N GRAND AVE STE 150",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032755",
            "telephone_number": "719-595-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "CORAL",
        "middle_name": "BREANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-17",
        "last_updated": "2018-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "APN.0994299-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.