NPIMap

Individual provider Active NPI

Krynn Louis Stegelmeier, MD

  • Diagnostic Radiology Physician
  • Pueblo, CO
National Provider Identifier
1063551083
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
DR.0052190 Issued in CO
Practice address
1619 N Greenwood St
Pueblo, CO 81003-2644
Phone
(719) 542-2167
NPI assigned
Feb 6, 2007
Last updated
Feb 21, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2006-0378 NM
Diagnostic Radiology Physician 2085R0202X DR.0052190 CO Primary

Addresses

Primary practice location

1619 N Greenwood St
Pueblo, CO 81003-2644

Mailing address

1533 Savannah Dr
Pueblo, CO 81005-3533
Phone (719) 429-7419

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130712000079 CO Practitioner - Diagnostic Radiology 9931355328 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Colorado School of Medicine, Denver, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Radiologists, P.C.Group PAC ID 7517959794, 11 clinicians
Parkwest Imaging, L.L.CGroup PAC ID 3173415247, 11 clinicians

Practice addresses (Care Compare)

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2655
Phone (719) 542-2167

3676 Parker Blvd
Suite 165
Pueblo, CO 81008-2212
Phone (719) 595-7600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2006-0378NMMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Radiologists, P.C. CurrentSince Jul 1, 2013 Accepting new patients
Parkwest Imaging, L.L.C Diagnostic Radiology CurrentSince Jul 1, 2013 Accepting new patients
Radiology Associates Diagnostic Radiology PastSince Jul 1, 2013 Accepting new patients

Locations

1619 N Greenwood St
Ste 103
Pueblo, CO 81003
Phone (719) 542-2167

3676 Parker Blvd
Ste 165
Pueblo, CO 81008
Phone (719) 253-7040

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1063551083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1533 SAVANNAH DR",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053533",
            "telephone_number": "719-429-7419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032644",
            "telephone_number": "719-542-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEGELMEIER",
        "first_name": "KRYNN LOUIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NM",
            "license": "2006-0378",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "DR.0052190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.