NPIMap

Organization Active NPI

Spine Colorado PC

  • Orthopaedic Surgery of the Spine Physician
  • Durango, CO
National Provider Identifier
1083665657
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
Legal business name
SPINE COLORADO PC
Practice address
1 Mercado St
Ste 200
Durango, CO 81301-7300
Phone
(970) 382-9500
Fax
(970) 375-0007
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Authorized official

Name
Katya Licciardi, CPC
Title
Reimbursement Analyst
Phone
(970) 375-3661

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0117X Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X

Addresses

Primary practice location

1 Mercado St
Ste 200
Durango, CO 81301-7300

Mailing address

1 Mercado St
Ste 200
Durango, CO 81301-7300
Phone (970) 382-9500

Other practice location 1

314 S 6th St
Montrose, CO 81401-5719
Phone (970) 382-9500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310001215 CO Part B Supplier - Clinic/Group Practice 0941199830 Receives reassigned benefits from 9 practitioners
Practice locations: Durango, CO; Montrose, CO

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

555 Rivergate Ln
Ste B2-135
Durango, CO 81301
Phone (970) 828-0420

5203 Juan Tabo Blvd NE
Ste 1C
Albuquerque, NM 87111
Phone (505) 299-4900

2700 Farmington Ave
Bldg E
Farmington, NM 87401
Phone (505) 325-2323

804 N 400 W
Blanding, UT 84511
Phone (435) 259-2508

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16938/brand/1/csg/21/fhir/r4

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1083665657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MERCADO ST",
            "address_2": "STE 200",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017300",
            "telephone_number": "970-382-9500",
            "fax_number": "970-375-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERCADO ST",
            "address_2": "STE 200",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017300",
            "telephone_number": "970-382-9500",
            "fax_number": "970-375-0007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "314 S 6th St",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "CO",
            "postal_code": "814015719",
            "country_code": "US",
            "telephone_number": "970-382-9500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPINE COLORADO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "LICCIARDI",
        "authorized_official_first_name": "KATYA",
        "authorized_official_title_or_position": "REIMBURSEMENT ANALYST",
        "authorized_official_telephone_number": "970-375-3661",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; 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.