Intermountain Medical Group Denver, LLC
Organization Active NPI Family Medicine Physician · Arvada, CO
NPI 1043973902 · NPPES record last updated Jun 28, 2024
Key facts
- NPI
- 1043973902
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
- Practice address
- 15389 W 91St Dr Ste 100
Arvada, CO 80007-1400 - Phone
- (303) 603-9300
- Fax
- (720) 501-6699
- NPI assigned
- Oct 18, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- INTERMOUNTAIN FRONT RANGE, INC.
Authorized official
- Name
- Jon McDaniel
- Title
- VP Finance Med Group
- Phone
- (303) 272-0231
Corporate family (same tax ID) 15
Practitioners 14
-
Chynna Elaine Darling, PT,DPT
-
Hope Engel, PT
-
Anette M Kunig, MD
-
Laura Jean Laporta, PT, PHD
-
Allison Luellen, PA-C
-
Harmony Mueth, PT
-
Courtney Mullins, MD
-
Frances Louise Westlake, PT, DPT
-
Emily Brie Hecker, PA-C
-
Carly Ann Olver, DPT, PT
-
Sagun Kaur Tuli, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150106000131 | CO | Part B Supplier - Clinic/Group Practice | 0840513552 |
Receives reassigned benefits from 1,361 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Intermountain Medical Group Denver LLC
- Part of
- Lutheran Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Podiatric Clinic/Center | 261QP1100X |
Addresses
Primary practice location
15389 W 91St Dr Ste 100
Arvada, CO 80007-1400
Mailing address
500 Eldorado Blvd Ste 6300
Broomfield, CO 80021-3422
Phone (303) 272-0566
Other names
- Candelas Clinic - Primary Care
- Candelas Clinic - Podiatry
Other providers in Arvada, CO
- Innate Wisdom Psychiatry & Wellness
- Inner Door Therapy LLC
- Carleen R Innes
- Integrated Awakening LLC
- Integrated Family Wellness, Training & Consulting
- Intermountain Medical Group Denver, LLC
- Vonda Ioan
- Iora Health Colorado, P.C.
- Iora Senior Health, LLC
- Cynthia J Ireland
All providers in Arvada, CO · Family Medicine Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.