NPIMap

Organization Active NPI

Community Medical Group, LLC

Doing business as Grand Valley Primary Care III

  • Family Medicine Physician
  • Grand JCT, CO
National Provider Identifier
1114564952
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMMUNITY MEDICAL GROUP, LLC
Doing business as
Grand Valley Primary Care III
Practice address
2478 Patterson Rd Ste 27
Grand JCT, CO 81505-3606
Phone
(970) 644-4300
Fax
(970) 263-4323
NPI assigned
Nov 27, 2019
Last updated
Apr 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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

Authorized official

Name
Christian Thomas
Title
President/Ceo
Phone
(970) 644-3011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2478 Patterson Rd Ste 27
Grand JCT, CO 81505-3606

Mailing address

PO Box 1727
Grand Junction, CO 81502-1727
Phone (970) 644-4300

Other practice location 1

2373 G Rd Ste 160
Grand Junction, CO 81505-1003
Phone (970) 644-4300

Other names 1

  • GRAND VALLEY PRIMARY CARE III Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151222000695 CO Part B Supplier - Clinic/Group Practice 1052612785 Receives reassigned benefits from 123 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Junction, CO; Meeker, CO; Palisade, CO; Rangely, CO; Grand JCT, CO; Fruita, CO; Delta, CO; Clifton, CO

Other NPIs on the same Medicare enrollment 19

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

View all 19

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
06D2074219Grand Valley Primary Care - III2478 Patterson, Unit 27, Grand Junction, CO 81505Provider-performed microscopyNov 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Community Medical Group28 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

Practitioners & affiliated clinicians

Practitioners 12

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": "1574812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618185600000",
    "number": "1114564952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1727",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815021727",
            "telephone_number": "970-644-4300",
            "fax_number": "970-263-4323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2478 PATTERSON RD STE 27",
            "city": "GRAND JCT",
            "state": "CO",
            "postal_code": "815053606",
            "telephone_number": "970-644-4300",
            "fax_number": "970-263-4323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2373 G Rd Ste 160",
            "address_purpose": "LOCATION",
            "city": "Grand Junction",
            "state": "CO",
            "postal_code": "815051003",
            "country_code": "US",
            "telephone_number": "970-644-4300",
            "fax_number": "970-263-2692",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-27",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "970-644-3011"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND VALLEY PRIMARY CARE III",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand JCT, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.