Intermountain Medical Group Denver, LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

INTERMOUNTAIN MEDICAL GROUP DENVER, LLC

Doing business as

Lafayette Clinic Neurology

Practice address

300 Exempla Cir Ste 230
Lafayette, CO 80026-2906

Phone

(303) 673-1370

Fax

(720) 616-6995

NPI assigned

Mar 8, 2022

Last updated

Jun 28, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

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

Authorized official

Name

Jon McDaniel

Title

VP Finance

Phone

(303) 272-0231

Specialties & licenses 1

Addresses

Other names 1

• Lafayette Clinic Neurology Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Part of

Exempla Healthcare

Practitioners 3

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.

• David Phillip Baldwin, DO

  • Hospitalist Physician
  • Parker, CO
  • NPI 1023645959
  NPD
• Jason Yu Wang, MD

  • Hospitalist Physician
  • Wheat Ridge, CO
  • NPI 1699235523
  NPD
• Chad Bolling Brinkman, PT, DPT

  • Physical Therapist
  • Tucson, AZ
  • NPI 1972094605
  NPD

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

{
    "created_epoch": "1646697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1114674363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 4300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 EXEMPLA CIR STE 230",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800262906",
            "telephone_number": "303-673-1370",
            "fax_number": "720-616-6995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2022-03-08",
        "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 FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lafayette Clinic Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Neurology Physician in Lafayette, CO
• Providers in Lafayette, CO by specialty
• Neurology Physician in Colorado

• 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.