NPIMap

Individual provider Active NPI

Thomas C Coburn, M.D.

  • Family Medicine Physician
  • Kremmling, CO
National Provider Identifier
1073562237
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36057 Issued in CO
Practice address
214 S. 4TH Street
Kremmling, CO 80459-0399
Phone
(970) 887-5800
NPI assigned
May 8, 2006
Last updated
Feb 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36057 CO Primary

Addresses

Primary practice location

214 S. 4TH Street
Kremmling, CO 80459-0399

Mailing address

4795 Larimer Parkway
Johnstown, CO 80534-9021
Phone (970) 669-8881

Other practice location 1

4795 Larimer Parkway
Johnstown, CO 80534-9021
Phone (970) 669-8881

Other identifiers 1

IdentifierTypeStateIssuer
01360577MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tcoburn100092@directe.centura.org Health Information Exchange (HIE)

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
I20100601000599 CO Practitioner - Family Practice 3173652161 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

214 S 4TH St
Kremmling, CO 80459-0399
Phone (970) 724-3442

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
73.61 of 100Reported as group
Quality
76.83
Promoting interoperability
100
Improvement activities
40
Cost
35.19

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kremmling Memorial Hospital District CurrentSince Jun 23, 2015 Accepting new patients
VMD Primary Providers Colorado, Inc Family Medicine Current Accepting new patients
Kremmling Memorial Hospital District CurrentSince Jun 23, 2015 Accepting new patients

Locations

3519 Richmond Dr
Fort Collins, CO 80526
Phone (970) 204-0300

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1073562237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4795 LARIMER PARKWAY",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "805349021",
            "telephone_number": "970-669-8881",
            "fax_number": "970-669-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 S. 4TH STREET",
            "city": "KREMMLING",
            "state": "CO",
            "postal_code": "804590399",
            "telephone_number": "970-887-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4795 Larimer Parkway",
            "address_purpose": "LOCATION",
            "city": "Johnstown",
            "state": "CO",
            "postal_code": "805349021",
            "country_code": "US",
            "telephone_number": "970-669-8881",
            "fax_number": "970-669-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COBURN",
        "first_name": "THOMAS",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "36057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01360577",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tcoburn100092@directe.centura.org",
            "affiliation": "N",
            "endpointDescription": "TCoburn Middle Park Health DIRECT Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "214 S. 4th Street",
            "city": "Kremmling",
            "state": "CO",
            "country_code": "US",
            "postal_code": "804590399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kremmling, CO

Sources for this page

Verify at the official NPI Registry.