NPIMap

Organization Active NPI

Platte Valley Medical Group, LLC

Doing business as Fort Lupton Walk In Care

  • Emergency Medicine Physician
  • Fort Lupton, CO
National Provider Identifier
1073139648
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
PLATTE VALLEY MEDICAL GROUP, LLC
Doing business as
Fort Lupton Walk In Care
Practice address
1450 Dexter St Ste 102
Fort Lupton, CO 80621-1503
Phone
(303) 857-7873
Fax
(303) 857-7926
NPI assigned
Jun 19, 2020
Last updated
Sep 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BRIGHTON COMMUNITY HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

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

Authorized official

Name
Jon McDaniel
Title
VP Finance
Phone
(303) 272-0231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1450 Dexter St Ste 102
Fort Lupton, CO 80621-1503

Mailing address

1450 Dexter St Ste 102
Fort Lupton, CO 80621-1503
Phone (303) 857-7873

Other names 1

  • Fort Lupton Walk In Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180112000840 CO Part B Supplier - Clinic/Group Practice 5890054100 Receives reassigned benefits from 201 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brighton, CO; Thornton, CO; Fort Lupton, CO; Denver, CO; Commerce City, CO

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory
Part of
Brighton Community Hospital Association

Locations

1450 Dexter St
Ste 102
Fort Lupton, CO 80621
Phone (303) 857-7873

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695772800000",
    "number": "1073139648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 DEXTER ST STE 102",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211503",
            "telephone_number": "303-857-7873",
            "fax_number": "303-857-7926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 DEXTER ST STE 102",
            "city": "FORT LUPTON",
            "state": "CO",
            "postal_code": "806211503",
            "telephone_number": "303-857-7873",
            "fax_number": "303-857-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLATTE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRIGHTON COMMUNITY HOSPITAL ASSOCIATION",
        "enumeration_date": "2020-06-19",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Lupton Walk In Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Lupton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.