NPIMap

Organization Active NPI

Pediatric Partners of the Southwest

  • Pediatrics Physician
  • Durango, CO
National Provider Identifier
1083717219
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC PARTNERS OF THE SOUTHWEST
Practice address
810 East 3Rd St, Suite #301
Pediatric Partners of the Southwest
Durango, CO 81301
Phone
(970) 375-0100
Fax
(970) 375-9210
NPI assigned
Sep 6, 2006
Last updated
Jun 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Authorized official

Name
Dr. Martha Cecile Fraley, MDNPI 1780701649
Title
Physician Administrator/ Ceo
Phone
(970) 375-0100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 33703 CO
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

810 East 3Rd St, Suite #301
Pediatric Partners of the Southwest
Durango, CO 81301

Mailing address

810 East 3Rd St Suite #301
Pediatric Partners of the Southwest
Durango, CO 81301
Phone (970) 375-0100

Other identifiers 4

IdentifierTypeStateIssuer
01337039MedicaidCO
40373037MedicaidCO
66033721MedicaidCO
948.84.315MedicaidCO

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D1040724Pediatric Partners of the Southwest810 E 3Rd St, Suite 301, Durango, CO 81301Certificate of waiverMay 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Partners of the Southwest PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1083717219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 EAST 3RD ST SUITE #301",
            "address_2": "PEDIATRIC PARTNERS OF THE SOUTHWEST",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "81301",
            "telephone_number": "970-375-0100",
            "fax_number": "970-375-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 EAST 3RD ST, SUITE #301",
            "address_2": "PEDIATRIC PARTNERS OF THE SOUTHWEST",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "81301",
            "telephone_number": "970-375-0100",
            "fax_number": "970-375-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS OF THE SOUTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "FRALEY",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "CECILE",
        "authorized_official_title_or_position": "PHYSICIAN ADMINISTRATOR/ CEO",
        "authorized_official_telephone_number": "970-375-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "33703",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01337039",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40373037",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66033721",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "948.84.315",
            "state": "CO"
        }
    ],
    "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 Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.