NPIMap

Organization Active NPI

Comfort Care Family Practice, Inc.

  • Family Medicine Physician
  • Fountain, CO
National Provider Identifier
1124441084
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
49109 Issued in CO
Legal business name
COMFORT CARE FAMILY PRACTICE, INC.
Practice address
6908 Mesa Ridge Pkwy
Fountain, CO 80817-1533
Phone
(719) 471-2273
Fax
(719) 380-0228
NPI assigned
Jan 29, 2014
Reactivated
Feb 14, 2024
Last updated
Feb 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Authorized official

Name
Anita Wiescamp
Title
Owner
Phone
(719) 510-0957

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 49109 CO Primary

Addresses

Primary practice location

6908 Mesa Ridge Pkwy
Fountain, CO 80817-1533

Mailing address

5799 Stetson Hills Blvd
Colorado Springs, CO 80917-4223
Phone (719) 471-2273

Other identifiers 1

IdentifierTypeStateIssuer
46324275MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111005000292 CO Part B Supplier - Clinic/Group Practice 1153593645 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO; Fountain, CO; Pueblo, CO

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Comfort Care Family Practice Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

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": "1390953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1124441084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5799 STETSON HILLS BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809174223",
            "telephone_number": "719-471-2273",
            "fax_number": "719-380-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6908 MESA RIDGE PKWY",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808171533",
            "telephone_number": "719-471-2273",
            "fax_number": "719-380-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMFORT CARE FAMILY PRACTICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-29",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "deactivation_date": "2024-01-25",
        "reactivation_date": "2024-02-14",
        "status": "A",
        "authorized_official_last_name": "WIESCAMP",
        "authorized_official_first_name": "ANITA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-510-0957"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "49109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46324275",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.