Active NPI
Boulder Plastic Surgery Prof LLC
- Specialist
- Boulder, CO
National Provider Identifier
1033705926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Legal business name
- BOULDER PLASTIC SURGERY PROF LLC
- Practice address
- 4747 Arapahoe Ave
Boulder, CO 80303-1131 - Phone
- (720) 854-7000
- NPI assigned
- Dec 15, 2020
- Last updated
- Dec 15, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Pam Garcia
- Title
- Office Contact
- Phone
- (303) 443-2277
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NU | Primary |
Addresses
Primary practice location
4747 Arapahoe Ave
Boulder, CO 80303-1131
Mailing address
PO Box 7643
Loveland, CO 80537-0643
Phone (970) 663-2742
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040302000408 | CO | Part B Supplier - Clinic/Group Practice | 0941197248 |
Receives reassigned benefits from 3 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boulder, CO |
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607990400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607990400000",
"number": "1033705926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7643",
"city": "LOVELAND",
"state": "CO",
"postal_code": "805370643",
"telephone_number": "970-663-2742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4747 ARAPAHOE AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803031131",
"telephone_number": "720-854-7000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BOULDER PLASTIC SURGERY PROF LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-12-15",
"last_updated": "2020-12-15",
"certification_date": "2020-12-15",
"status": "A",
"authorized_official_last_name": "GARCIA",
"authorized_official_first_name": "PAM",
"authorized_official_title_or_position": "OFFICE CONTACT",
"authorized_official_telephone_number": "303-443-2277"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
- Boulder Nutrition & Exercise Services, LLC
- Boulder Oral Surgery
- Boulder Orthodontics
- Boulder Pain Institute, PC
- Boulder Peak Family Practice, Inc.
- Boulder Plastic Surgery Prof LLC
- Boulder Plastic Surgery Prof LLC
- Boulder Plastic Surgery Prof LLC
- Boulder Pride Dba Rocky Mountain Equality
- Boulder Pride Dba Rocky Mountain Equality (Rocky Mountain Equality)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.