NPIMap

Organization Active NPI

Pediatrics 5280, PC

  • Pediatrics Physician
  • Castle Rock, CO
National Provider Identifier
1134545395
Registry record updated Mar 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRICS 5280, PC
Practice address
2352 Meadows Blvd
Suite 150
Castle Rock, CO 80109
Phone
(303) 779-5437
NPI assigned
Mar 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2014

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

Authorized official

Name
Mike Ripperton
Title
Administrator
Phone
(303) 779-5437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2352 Meadows Blvd
Suite 150
Castle Rock, CO 80109

Mailing address

9094 E Mineral Cir
Ste 120
Centennial, CO 80112-7200

Other identifiers 1

IdentifierTypeStateIssuer
04013280MedicaidCO

Other names 1

  • Pediatrics DTC, PC Former legal business name

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
06D2061063Pediatrics 5280, PC2352 Meadows Blvd, Ste 150, Castle Rock, CO 80109Certificate of waiverMay 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pediatrics 52802 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

9094 E Mineral Cir
Ste 120
Centennial, CO 80112
Phone (303) 779-5437

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394582400000",
    "number": "1134545395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9094 E MINERAL CIR",
            "address_2": "STE 120",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801127200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2352 MEADOWS BLVD",
            "address_2": "SUITE 150",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "80109",
            "telephone_number": "303-779-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS 5280, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-12",
        "last_updated": "2014-03-12",
        "status": "A",
        "authorized_official_last_name": "RIPPERTON",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "303-779-5437"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04013280",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatrics DTC, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Castle Rock, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.