Individual provider Active NPI

Daniel Dean Fathalikhani, DO

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1114629714
Registry record updated Jul 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0078050 Issued in CO
Practice address
2919 Valmont Rd Ste 204
Boulder, CO 80301-1350
Phone
(303) 938-1110
NPI assigned
Mar 20, 2023
Last updated
Jul 6, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2026

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 DR.0078050 CO Primary

Addresses

Primary practice location

2919 Valmont Rd Ste 204
Boulder, CO 80301-1350

Mailing address

2919 Valmont Rd Ste 204
Boulder, CO 80301-1350
Phone (303) 938-1110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241219004179 VA Order and Referring Only - Family PracticePractitioner - Family Practice 6002343688

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wisdom Health PC PastSince Aug 10, 2020 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: daniel.fathalikhani@hca6.eclinicaldirectplus.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1114629714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 VALMONT RD STE 204",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011350",
            "telephone_number": "303-938-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2919 VALMONT RD STE 204",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011350",
            "telephone_number": "303-938-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FATHALIKHANI",
        "first_name": "DANIEL",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-20",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0078050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.