NPIMap

Organization Active NPI

Colorado Mountain Medical, LLC

  • Community/Behavioral Health Agency
  • Edwards, CO
National Provider Identifier
1093328320
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COLORADO MOUNTAIN MEDICAL, LLC
Practice address
429 Edwards Access Rd Unit A207
Edwards, CO 81632-5559
Phone
(970) 926-6340
Fax
(970) 926-6348
NPI assigned
Aug 26, 2020
Last updated
Jan 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Authorized official

Name
Diane VoytkoNPI 1043212525
Title
Physician 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
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

429 Edwards Access Rd Unit A207
Edwards, CO 81632-5559

Mailing address

PO Box 4330
Avon, CO 81620-4330
Phone (970) 926-6340

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191030000595 CO Part B Supplier - Clinic/Group Practice 5496087181 Receives reassigned benefits from 70 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vail, CO; Glenwood Spring, CO; Frisco, CO; Edwards, CO; Eagle, CO; Avon, CO; Dillon, CO

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Colorado Mountain Medical LLC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Vail Clinic Inc

    dba Shaw Cancer Center - Service of Vail Health Hospital

    • General Acute Care Hospital
    • Edwards, CO
    • NPI 1144876251

    Member Of

    NPD member

Practitioners & affiliated clinicians

Practitioners 4

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": "1598400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1093328320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4330",
            "city": "AVON",
            "state": "CO",
            "postal_code": "816204330",
            "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": "429 EDWARDS ACCESS RD UNIT A207",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816325559",
            "telephone_number": "970-926-6340",
            "fax_number": "970-926-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO MOUNTAIN MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-26",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "VOYTKO",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PHYSICIAN PRESIDENT",
        "authorized_official_telephone_number": "970-926-6340"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwards, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.