Portercare Adventist Health System
Organization Active NPI Family Medicine Physician · Denver, CO
NPI 1053923672 · NPPES record last updated Aug 14, 2026
Key facts
- NPI
- 1053923672
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- PORTERCARE ADVENTIST HEALTH SYSTEM
- Practice address
- 7000 E Hampden Ave Ste 200
Denver, CO 80224-3012 - Phone
- (303) 925-4960
- Fax
- (303) 925-4691
- NPI assigned
- Aug 17, 2020
- Organization subpart
- No
Authorized official
- Name
- Mr. Jason Tacha
- Title
- Coo
- Phone
- (303) 304-7752
Corporate family (same tax ID) 20
Practitioners 8
-
Kira Miyoko Lebsack, AG-NP
-
Kimberly F. Madden, PA-C
-
Kimberly Mahowald, NP-C
-
Melissa J Page, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090115000327 | CO | Part B Supplier - Clinic/Group Practice | 0941110886 |
Receives reassigned benefits from 869 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Avista Adventist Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
7000 E Hampden Ave Ste 200
Denver, CO 80224-3012
Mailing address
PO Box 713425
Chicago, IL 60677-4325
Phone (800) 953-0104
Other names
- AdventHealth Medical Group Primary Care at Southmoor
- CHPG Primary Care Southmoor
Other providers in Denver, CO
- Walter Porter Jr.
- William Wales Porter
- Portercare Adventist Health System
- Portercare Adventist Health System
- Portercare Adventist Health System
- Portercare Adventist Health System
- Portercare Adventist Health System
- Portercare Adventist Health System
- Portercare Adventist Health System
- Portercare Adventist Health System
All providers in Denver, 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 Aug 14, 2026. 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.