NPIMap

Organization Active NPI

Spine Group LLC

Doing business as The Spine Group LLC

  • Multi-Specialty Clinic/Center
  • Westminster, CO
National Provider Identifier
1033486006
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SPINE GROUP LLC
Doing business as
The Spine Group LLC
Practice address
12061 Tejon St Ste 600
Westminster, CO 80234-2325
Phone
(303) 457-0123
Fax
(303) 252-4065
NPI assigned
Nov 18, 2011
Last updated
Nov 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Authorized official

Name
Warner M Hettick, DCNPI 1134445984
Title
Authorized Official
Phone
(303) 457-0123

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Chiropractor 111N00000X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

12061 Tejon St Ste 600
Westminster, CO 80234-2325

Mailing address

12061 Tejon St Ste 600
Westminster, CO 80234-2325
Phone (303) 457-0123

Other names 1

  • The Spine Group LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120619000479 CO Part B Supplier - Clinic/Group Practice 5698938298 Receives reassigned benefits from 4 practitioners
Practice locations: Westminster, CO

National Provider Directory

National Provider Directory

Locations

2205 W 136th Ave
Ste 112
Broomfield, CO 80023
Phone (303) 457-0123

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1033486006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12061 TEJON ST STE 600",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802342325",
            "telephone_number": "303-457-0123",
            "fax_number": "303-252-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12061 TEJON ST STE 600",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802342325",
            "telephone_number": "303-457-0123",
            "fax_number": "303-252-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "HETTICK",
        "authorized_official_first_name": "WARNER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "303-457-0123",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Spine Group LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Spine Group LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westminster, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; 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.