Big Tree Medical Group LLC

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

BIG TREE MEDICAL GROUP LLC

Doing business as

Big Tree Medical Group LLC

Practice address

1701 S Federal Blvd
Denver, CO 80219-4898

Phone

(720) 323-0621

Fax

(303) 934-4036

NPI assigned

Feb 16, 2022

Last updated

Mar 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Antony Nguyen Vanbang, MD

Title

Primary Provider

Phone

(720) 323-0621

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• BIG TREE MEDICAL GROUP LLC Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1063167211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 S FEDERAL BLVD",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802194898",
            "telephone_number": "720-323-0621",
            "fax_number": "303-934-4036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 S FEDERAL BLVD",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802194898",
            "telephone_number": "720-323-0621",
            "fax_number": "303-934-4036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG TREE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "VANBANG",
        "authorized_official_first_name": "ANTONY",
        "authorized_official_middle_name": "NGUYEN",
        "authorized_official_title_or_position": "PRIMARY PROVIDER",
        "authorized_official_telephone_number": "720-323-0621",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO DEPARTMENT OF REGULATORY AGENCIES DIVISION OF PROFESSIONS AND OCCUPATIO",
            "identifier": "DR.0054747",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "OFFICALLY.COM",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "1701 S. FEDERAL BLVD",
            "city": "DENVER",
            "state": "CO",
            "country_code": "US",
            "postal_code": "80219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BIG TREE MEDICAL GROUP LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BIG TREE MEDICAL GROUP LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Denver, CO
• Providers in Denver, CO by specialty
• Federally Qualified Health Center (FQHC) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.