NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

  • Surgery Physician
  • Wheat Ridge, CO
National Provider Identifier
1114593571
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Practice address
3455 Lutheran Pkwy Ste 220
Wheat Ridge, CO 80033-6029
Phone
(303) 403-3030
Fax
(303) 403-6907
NPI assigned
May 27, 2021
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

Authorized official

NPPES NPI Registry
Name
Jon McDaniel
Title
VP of Finance
Phone
(303) 272-0231

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20150106000131 CO Part B Supplier - Clinic/Group Practice 0840513552 Receives reassigned benefits from 1,361 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Lutheran Medical Center

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

NPPES NPI Registry

Primary practice location

3455 Lutheran Pkwy Ste 220
Wheat Ridge, CO 80033-6029

Mailing address

500 Eldorado Blvd Ste 6300
Broomfield, CO 80021-3422
Phone (303) 272-0566

Other names 1

NPPES NPI Registry
  • Wheat Ridge Clinic - Weight Loss & Reflux Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 28, 2024.

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1114593571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 6300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213422",
            "telephone_number": "303-272-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 LUTHERAN PKWY STE 220",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336029",
            "telephone_number": "303-403-3030",
            "fax_number": "303-403-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2021-05-27",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wheat Ridge Clinic - Weight Loss & Reflux Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheat Ridge, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.