NPIMap

Organization Active NPI

Boulder Valley Center for Dermatology LLC

  • Dermatology Physician
  • Boulder, CO
National Provider Identifier
1063018000
Registry record updated May 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BOULDER VALLEY CENTER FOR DERMATOLOGY LLC
Practice address
3000 Center Green Dr Ste 260
Boulder, CO 80301-2319
Phone
(303) 604-1444
Fax
(303) 666-0911
NPI assigned
Dec 7, 2020
Last updated
May 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2024

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

Authorized official

Name
Sadie Nealy
Title
Assistant Billing Manager
Phone
(970) 430-4602

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

3000 Center Green Dr Ste 260
Boulder, CO 80301-2319

Mailing address

PO Box 272308
Fort Collins, CO 80527-2308
Phone (303) 604-1444

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
06D2344921Boulder Valley Center for Dermatology PLLC3000 Center Green Drive, Suite 260, Boulder, CO 80301Provider-performed microscopyJun 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Boulder Valley Center for Dermatolo2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2831/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1063018000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 272308",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805272308",
            "telephone_number": "303-604-1444",
            "fax_number": "970-484-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 CENTER GREEN DR STE 260",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012319",
            "telephone_number": "303-604-1444",
            "fax_number": "303-666-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER VALLEY CENTER FOR DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2024-05-13",
        "certification_date": "2023-12-20",
        "status": "A",
        "authorized_official_last_name": "NEALY",
        "authorized_official_first_name": "SADIE",
        "authorized_official_title_or_position": "ASSISTANT BILLING MANAGER",
        "authorized_official_telephone_number": "970-430-4602"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.