NPIMap

Individual provider Active NPI

Shane Rothermel, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Pueblo, CO
National Provider Identifier
1083000541
Registry record updated Oct 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
DR0065962 Issued in CO
Practice address
3676 Parker Blvd Ste 390
Pueblo, CO 81008-2215
Phone
(719) 595-7780
Fax
(719) 595-7789
NPI assigned
Apr 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 25MA10759000 NJ
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X MD462106 PA
Student in an Organized Health Care Education/Training Program 390200000X
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X DR0065962 CO Primary

Addresses

Primary practice location

3676 Parker Blvd Ste 390
Pueblo, CO 81008-2215

Mailing address

2500 English Creek Ave Ste 1300
Egg Harbor Township, NJ 08234-5598
Phone (609) 677-7013

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
I20210824002774 CO Practitioner - Orthopedic Surgery 0648550285 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Pennsylvania State University College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

3676 Parker Blvd
Pueblo, CO 81008-2213

3676 Parker Blvd
Suite 390
Pueblo, CO 81008-2215
Phone (719) 595-7780

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement59
Knee replacement66
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR0065962COMDAdult Reconstructive Orthopaedic Surgery Physician
25MA10759000NJMDAdult Reconstructive Orthopaedic Surgery Physician
MD462106PAMDAdult Reconstructive Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Jun 1, 2025 Accepting new patients
Poudre Valley Medical Group, LLC Orthopaedic Surgery CurrentSince Jun 1, 2025 Accepting new patients
Parkview Medical Center, Inc. Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

3676 Parker Blvd
Ste 350
Pueblo, CO 81008
Phone (719) 296-6000

1619 N Greenwood St
Ste 106
Pueblo, CO 81003
Phone (719) 595-7760

58 Club Manor Dr
Pueblo, CO 81008
Phone (719) 584-4045

3676 Parker Blvd
Ste 390
Pueblo, CO 81008
Phone (719) 595-7780

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1428710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635552000000",
    "number": "1083000541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 ENGLISH CREEK AVE STE 1300",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082345598",
            "telephone_number": "609-677-7013",
            "fax_number": "609-677-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3676 PARKER BLVD STE 390",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082215",
            "telephone_number": "719-595-7780",
            "fax_number": "719-595-7789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTHERMEL",
        "first_name": "SHANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-11",
        "last_updated": "2021-10-30",
        "certification_date": "2021-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "NJ",
            "license": "25MA10759000",
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "PA",
            "license": "MD462106",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "CO",
            "license": "DR0065962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.