NPIMap

Organization Active NPI

Colorado Mountain Medical, PC

  • Family Medicine Physician
  • Avon, CO
National Provider Identifier
1083675102
Registry record updated Sep 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COLORADO MOUNTAIN MEDICAL, PC
Practice address
50 Buck Creek Road
Suite 200
Avon, CO 81620
Phone
(970) 926-6340
Fax
(970) 926-6348
NPI assigned
Mar 29, 2006
Last updated
Sep 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2016

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

Authorized official

Name
Dr. Janet Engle, MDNPI 1275503682
Title
President
Phone
(970) 926-6340

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Gastroenterology Physician 207RG0100X NU
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

50 Buck Creek Road
Suite 200
Avon, CO 81620

Mailing address

PO Box 5850
C/O Credentialing - Lisa Kerstiens
Eagle, CO 81631-5850
Phone (970) 926-6340

Other identifiers 1

IdentifierTypeStateIssuer
04005617MedicaidCO

National Provider Directory

National Provider Directory

Locations

322 Beard Creek Rd
Ste 200
Edwards, CO 81632
Phone (970) 328-1650

108 S Frontage Rd W
Ste 101
Vail, CO 81657

181 W Meadow Dr
Ste 3R
Vail, CO 81657
Phone (970) 476-8116

Practitioners & affiliated clinicians

Practitioners 69

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.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475107200000",
    "number": "1083675102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5850",
            "address_2": "C/O CREDENTIALING - LISA KERSTIENS",
            "city": "EAGLE",
            "state": "CO",
            "postal_code": "816315850",
            "telephone_number": "970-926-6340",
            "fax_number": "970-926-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BUCK CREEK ROAD",
            "address_2": "SUITE 200",
            "city": "AVON",
            "state": "CO",
            "postal_code": "81620",
            "telephone_number": "970-926-6340",
            "fax_number": "970-926-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO MOUNTAIN MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2016-09-29",
        "status": "A",
        "authorized_official_last_name": "ENGLE",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-926-6340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04005617",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.