NPIMap

Organization Active NPI

Magnolia Medical Company

  • Addiction Medicine (Internal Medicine) Physician
  • Denver, CO
National Provider Identifier
1043769862
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
MAGNOLIA MEDICAL COMPANY
Practice address
2925 E Colfax Ave
Denver, CO 80206-1604
Phone
(303) 209-5115
Fax
(720) 638-5562
NPI assigned
Sep 22, 2016
Last updated
Feb 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Authorized official

Name
Pradeep Raj Rai
Title
Medical Director
Phone
(303) 209-5115

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Clinical Medical Laboratory 291U00000X 06D2121590 CO

Addresses

Primary practice location

2925 E Colfax Ave
Denver, CO 80206-1604

Mailing address

PO Box 29605
Dept # 800927
Phoenix, AZ 85038-9605
Phone (303) 209-5115

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171211000760 CO Part B Supplier - Clinic/Group Practice 0749548253 Receives reassigned benefits from 45 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wheat Ridge, CO; Denver, CO

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1850 Race St
Denver, CO 80206
Phone (303) 209-5115

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771286400000",
    "number": "1043769862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29605",
            "address_2": "DEPT # 800927",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850389605",
            "telephone_number": "303-209-5115",
            "fax_number": "720-638-5562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 E COLFAX AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802061604",
            "telephone_number": "303-209-5115",
            "fax_number": "720-638-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MEDICAL COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-22",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A",
        "authorized_official_last_name": "RAI",
        "authorized_official_first_name": "PRADEEP",
        "authorized_official_middle_name": "RAJ",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "303-209-5115"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CO",
            "license": "06D2121590",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; 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.