Southern Colorado Nephrology Assoc PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHERN COLORADO NEPHROLOGY ASSOC PC

Practice address

3426 Lake Ave
120
Pueblo, CO 81004-3877

Phone

(719) 561-5264

Fax

(719) 561-5272

NPI assigned

Jun 29, 2006

Last updated

Nov 2, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Juliette Giebel

Title

Office Manager

Phone

(719) 561-5264

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

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.

• Christine B Baugh, NP

  • Nurse Practitioner
  • Pueblo, CO
  • NPI 1104946656
  Medicare reassignment Care Compare group NPD
• Stephen Theodore Brown, MD

  • Nephrology Physician
  • Pueblo, CO
  • NPI 1952309817
  Medicare reassignment Care Compare group NPD
• Scott William Harberts, MD

  • Nephrology Physician
  • Pueblo, CO
  • NPI 1477551521
  Medicare reassignment Care Compare group NPD
• Pamela Isley, NP

  • Adult Health Nurse Practitioner
  • Pueblo, CO
  • NPI 1528211760
  Medicare reassignment Care Compare group NPD
• Deepa Nagaraja, MD

  • Nephrology Physician
  • Pueblo, CO
  • NPI 1396009734
  Medicare reassignment Care Compare group NPD
• Stanley Carlos Sicher, MD

  • Nephrology Physician
  • Pueblo, CO
  • NPI 1295733350
  Medicare reassignment Care Compare group NPD
• Irina Vancea, MD

  • Nephrology Physician
  • Pueblo, CO
  • NPI 1205919750
  Medicare reassignment Care Compare group NPD
• Pamela Joy Cornella, NP

  • Nurse Practitioner
  • Pueblo, CO
  • NPI 1790975043
  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193961600000",
    "number": "1083642144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3426 LAKE AVE",
            "address_2": "120",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043877",
            "telephone_number": "719-561-5264",
            "fax_number": "719-561-5272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3426 LAKE AVE",
            "address_2": "120",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043877",
            "telephone_number": "719-561-5264",
            "fax_number": "719-561-5272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO NEPHROLOGY ASSOC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-11-02",
        "status": "A",
        "authorized_official_last_name": "GIEBEL",
        "authorized_official_first_name": "JULIETTE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "719-561-5264"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04006250",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Colorado Eye Care Associates PC
• Southern Colorado Family Medicine
• Southern Colorado Health & Rehab (Momentum Physical Therapy of Pueblo)
• Southern Colorado Health & Rehab (Momentum Physical Therapy of Pueblo)
• Southern Colorado Health & Rehab (Momentum Physical Therapy of Pueblo)
• Southern Colorado Orthodontics, PLLC
• Southern Colorado Pathology PLLC
• Southern Colorado Psychiatric P.C.
• Southern Colorado Radiologists, P.C.
• Southern Colorado Speech Therapy LLC

• Specialist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Specialist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.