Poudre Valley Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

POUDRE VALLEY MEDICAL GROUP, LLC

Practice address

620 Iris Dr
Sterling, CO 80751-4716

Phone

(970) 522-7266

NPI assigned

Sep 13, 2010

Organization subpart

Yes

Parent organization

POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Jana Conroy

Title

Director of Credentialing

Phone

(970) 522-7266

Specialties & licenses 2

Addresses

Other names 1

• UCHealth Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Other NPIs on the same Medicare enrollment 3

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

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868

  O20100602000122

  Same enrollment
• Poudre Valley Medical Group, LLC

  • Internal Medicine Physician
  • Fort Collins, CO
  • NPI 1285931865

  O20100602000122

  Same enrollment
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260

  O20100602000122

  Same enrollment

Part of

Poudre Valley Medical LLC

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1104133073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-522-7266",
            "fax_number": "970-522-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 IRIS DR",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807514716",
            "telephone_number": "970-522-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2010-09-13",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "970-522-7266"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Philip James Pollock, D.C., DABCI
• Dani June Powell, RDH
• Laura Powell, BA
• Wendi Powell
• Pradera Dental, P.C.
• Principled Service Internal Medicine

• Family Medicine Physician in Sterling, CO
• Providers in Sterling, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.