Individual provider Active NPI

Edward Shuherk, M.D.

  • Family Medicine Physician
  • Lakewood, CO
National Provider Identifier
1033166251
Registry record updated Jun 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37303 Issued in IA
Practice address
12790 W Alameda Pkwy
Lakewood, CO 80228-2859
Phone
(303) 403-6350
Fax
(303) 403-6372
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R7704 IA
Family Medicine Physician 207Q00000X 37303 IA Primary

Addresses

Primary practice location

12790 W Alameda Pkwy
Lakewood, CO 80228-2859

Mailing address

12790 W Alameda Pkwy
Lakewood, CO 80228-2859
Phone (303) 403-6350

Other identifiers 3

IdentifierTypeStateIssuer
0469940MedicaidIA
P00741121OtherIARR MEDICARE
1033166251MedicaidIA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160728001995 CO Practitioner - Family Practice 9931297900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians

Practice addresses (Care Compare)

Broomfield, CO 80021
Phone (720) 807-4461

12790 W Alameda Pkwy a
Green Mountain Clinic Primary Care
Lakewood, CO 80228-2850
Phone (303) 403-6350

400 Indiana St
Golden, CO 80401-5033
Phone (720) 452-1267

8350 Colorado Blvd
Unit 160
Firestone, CO 80504-6803
Phone (303) 673-1370

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R7704IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC CurrentSince Sep 1, 2016 Accepting new patients
Intermountain Medical Group Denver, LLC Family Medicine CurrentSince Sep 1, 2016 Accepting new patients

Locations

12790 W Alameda Pkwy
Lakewood, CO 80228
Phone (303) 403-6350

12790 W Alameda Pkwy
Ste A
Lakewood, CO 80228
Phone (303) 403-6350

Organizations & group practices 2

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 6

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1033166251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12790 W ALAMEDA PKWY",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282859",
            "telephone_number": "303-403-6350",
            "fax_number": "303-403-6372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12790 W ALAMEDA PKWY",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282859",
            "telephone_number": "303-403-6350",
            "fax_number": "303-403-6372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUHERK",
        "first_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R7704",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "37303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0469940",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00741121",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033166251",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.