NPIMap

Organization Active NPI

Portercare Adventist Health System

Doing business as AdventHealth Medical Group Urology at Lone Tree

  • Urology Physician
  • Lone Tree, CO
National Provider Identifier
1104661370
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
PORTERCARE ADVENTIST HEALTH SYSTEM
Doing business as
AdventHealth Medical Group Urology at Lone Tree
Practice address
9695 S Yosemite St Ste 359
Lone Tree, CO 80124-2888
Phone
(303) 825-8822
Fax
(303) 825-4022
NPI assigned
Jun 28, 2024
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Mr. Jason Tacha
Title
Coo
Phone
(303) 304-7752

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

9695 S Yosemite St Ste 359
Lone Tree, CO 80124-2888

Mailing address

PO Box 713425
Chicago, IL 60677-4325

Other names 1

  • AdventHealth Medical Group Urology at Lone Tree Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090115000327 CO Part B Supplier - Clinic/Group Practice 0941110886 Receives reassigned benefits from 869 practitioners
This NPI is an additional NPI on the enrollment

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
06D2215581Adventhealth Urology at Lone Tree9695 S Yosemite Dr, Ste 359, Lone Tree, CO 80124Certificate of waiverMar 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Portercare Adventist Health System216 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 5

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": "1719532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1104661370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713425",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606774325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9695 S YOSEMITE ST STE 359",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801242888",
            "telephone_number": "303-825-8822",
            "fax_number": "303-825-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTERCARE ADVENTIST HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "TACHA",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "303-304-7752",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Medical Group Urology at Lone Tree",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lone Tree, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.