NPIMap

Organization Active NPI

Boulder Community Health

  • Primary Care Clinic/Center
  • Superior, CO
National Provider Identifier
1053967869
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BOULDER COMMUNITY HEALTH
Practice address
3 Superior Dr Ste 100B
Superior, CO 80027-8653
Phone
(303) 415-8940
Fax
(303) 425-9259
NPI assigned
Aug 16, 2019
Organization subpart
Yes
Parent organization
BOULDER COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Authorized official

Name
William A Munson Jr.
Title
VP, Cfo
Phone
(303) 415-7433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

3 Superior Dr Ste 100B
Superior, CO 80027-8653

Mailing address

PO Box 9049
Boulder, CO 80301-9049
Phone (303) 415-8940

Other names 2

  • Community Medical Assoc of B.C.H. Doing business as
  • Northwest Family Medicine Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123000284 CO Part B Supplier - Clinic/Group Practice 6800707233 Receives reassigned benefits from 316 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Erie, CO; Superior, CO; Longmont, CO; Lafayette, CO; Boulder, CO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0510278Northwest Family Medical Associates,3 Superior Dr, Ste 100 B, Superior, CO 80027Certificate of waiverApr 7, 2028

National Provider Directory

National Provider Directory
Tax ID family
Michael Vongortler MD82 organizations share this tax ID, including this one
Part of
Michael Vongortler MD

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1053967869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9049",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803019049",
            "telephone_number": "303-415-8940",
            "fax_number": "303-425-9259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SUPERIOR DR STE 100B",
            "city": "SUPERIOR",
            "state": "CO",
            "postal_code": "800278653",
            "telephone_number": "303-415-8940",
            "fax_number": "303-425-9259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOULDER COMMUNITY HEALTH",
        "enumeration_date": "2019-08-16",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "MUNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP, CFO",
        "authorized_official_telephone_number": "303-415-7433",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Assoc of B.C.H.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Medical Assoc of B.C.H.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northwest Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Superior, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.