NPIMap

Individual provider Active NPI

Sameera F Fareed-Farrukh, M.D.

  • Internal Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1083600183
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0069803 Issued in CO
Practice address
175 S Union Blvd Ste 350
Colorado Springs, CO 80910-3146
Phone
(719) 633-5515
NPI assigned
Sep 23, 2005
Last updated
Jun 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 8201 NV
Internal Medicine Physician 207R00000X MD00045691 WA
Internal Medicine Physician 207R00000X 8201 NV
Internal Medicine Physician 207R00000X 7760A WY
Internal Medicine Physician 207R00000X DR.0069803 CO Primary

Addresses

Primary practice location

175 S Union Blvd Ste 350
Colorado Springs, CO 80910-3146

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071

Other identifiers 4

IdentifierTypeStateIssuer
DR.0069803OtherCOSTATE MEDICAL LICENSE
8201OtherNVSTATE MEDICAL LICENSE
002017004MedicaidNV
MD00045691OtherWASTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080318000216 WY Practitioner - Internal Medicine 8022019314 Reassigns benefits to 1 organization
I20231026002604 CO Practitioner - Internal Medicine 8022019314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians
Select Physical Therapy of Colorado Springs LPGroup PAC ID 3971498197, shared by 2 NPIs, 84 clinicians

Practice addresses (Care Compare)

10470 S Progress Way
Parker, CO 80134-4037
Phone (303) 617-4700

175 S Union Blvd
Suite 350 Uchealth Inter Med Clinic Printe
Colorado Springs, CO 80910-3146
Phone (719) 633-5515

5825 Delmonico Dr
Colorado Springs, CO 80919-2243
Phone (719) 257-4240

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8201NEMDMental Health Counselor
8201NVMDDentist
DR.0069803COMDInternal Medicine Physician
7760AWYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ivinson Memorial Hospital CurrentSince Jan 17, 2018 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 17, 2023 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 17, 2023 Accepting new patients
Ivinson Memorial Hospital CurrentSince Jan 17, 2018 Accepting new patients
Farrukh Javaid MD PLLC Internal Medicine Past Accepting new patients

Locations

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

175 S Union Blvd
Ste 350
Colorado Springs, CO 80910
Phone (719) 633-5515

8890 N Union Blvd
Ste 171
Colorado Springs, CO 80920
Phone (719) 364-4120

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

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319

255 N 30th St
Laramie, WY 82072
Phone (307) 742-2141

Organizations & group practices 5

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 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1083600183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 S UNION BLVD STE 350",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809103146",
            "telephone_number": "719-633-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAREED-FARRUKH",
        "first_name": "SAMEERA",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "8201",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00045691",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "8201",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WY",
            "license": "7760A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0069803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "DR.0069803",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "8201",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002017004",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "MD00045691",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.