NPIMap

Organization Active NPI

VVMC Diversified Services

Doing business as Vail Health Clinic Edwards

  • Cardiovascular Disease Physician
  • Edwards, CO
National Provider Identifier
1053909663
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
VVMC DIVERSIFIED SERVICES
Doing business as
Vail Health Clinic Edwards
Practice address
322 Beard Creek Rd Ste 1300
Edwards, CO 81632-6433
Phone
(970) 569-7656
NPI assigned
Jan 8, 2021
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
VVMC DIVERSIFIED SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Michael G Brown
Title
SVP & Cfo
Phone
(970) 479-7272

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary
Plastic Surgery Physician 208200000X
Surgery Physician 208600000X
Plastic and Reconstructive Surgery Physician 2086S0122X

Addresses

Primary practice location

322 Beard Creek Rd Ste 1300
Edwards, CO 81632-6433

Mailing address

PO Box 841152
Kansas City, MO 64184-1152
Phone (970) 777-2850

Other names 1

  • VAIL HEALTH CLINIC EDWARDS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080919000433 CO Part B Supplier - Clinic/Group Practice 8628145414 Receives reassigned benefits from 26 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vail, CO; Loveland, CO; Leadville, CO; Greeley, CO; Edwards, CO; Fort Collins, CO; Aurora, CO; Eagle, CO…

Other NPIs on the same Medicare enrollment 22

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

View all 22

National Provider Directory

National Provider Directory
Tax ID family
VVMC Diversified Services13 organizations share this tax ID, including this one
Part of
VVMC Diversified Services

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

180 S Frontage Rd W
Ste 5900
Vail, CO 81657
Phone (970) 479-5036

Practitioners & affiliated clinicians

Practitioners 1

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": "1610064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1053909663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841152",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641841152",
            "telephone_number": "970-777-2850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 BEARD CREEK RD STE 1300",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816326433",
            "telephone_number": "970-569-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VVMC DIVERSIFIED SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VVMC DIVERSIFIED SERVICES",
        "enumeration_date": "2021-01-08",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SVP & CFO",
        "authorized_official_telephone_number": "970-479-7272"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VAIL HEALTH CLINIC EDWARDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edwards, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; 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.