NPIMap

Individual provider Active NPI

David Corwin Braak, MD

  • Family Medicine Physician
  • Greeley, CO
National Provider Identifier
1104402205
Registry record updated Jul 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12959890-1205 Issued in UT
Practice address
1801 16TH St
Greeley, CO 80631-5199
Phone
(970) 810-4121
NPI assigned
Mar 20, 2021
Last updated
Jul 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12959890-1205 UT Primary

Addresses

Primary practice location

1801 16TH St
Greeley, CO 80631-5199

Mailing address

602 Denali CT
Windsor, CO 80550-3186
Phone (801) 357-1770

Other practice location 1

395 W Cougar Blvd Ste 205
Provo, UT 84604-3328
Phone (801) 357-1770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230214001667 UT Practitioner - Family Practice 8921470261 Reassigns benefits to 1 organization
I20240828004464 CO Practitioner - Family PracticePractitioner - Hospitalist 8921470261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
Medical University of South Carolina College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4593

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Nov 8, 2022 Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Sep 1, 2024 Accepting new patients
Banner Hospital Based Physicians Colorado LLC Current Accepting new patients
Banner Hospital Based Physicians Colorado LLC CurrentSince Sep 1, 2024 Accepting new patients
Ihc Health Services Inc Family Medicine CurrentSince Nov 8, 2022 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
North Colorado Medical Center Past Accepting new patients
North Colorado Medical Center Past Accepting new patients

Locations

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

2000 Boise Ave
Loveland, CO 80538
Phone (970) 635-4071

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

395 W Cougar Blvd
Ste 205
Provo, UT 84604
Phone (801) 357-1770

475 W 940 N
Provo, UT 84604
Phone (801) 357-7909

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1616198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721520000000",
    "number": "1104402205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 DENALI CT",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "805503186",
            "telephone_number": "801-357-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806315199",
            "telephone_number": "970-810-4121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "395 W Cougar Blvd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043328",
            "country_code": "US",
            "telephone_number": "801-357-1770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAAK",
        "first_name": "DAVID",
        "middle_name": "CORWIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-20",
        "last_updated": "2024-07-21",
        "certification_date": "2024-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "12959890-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.