NPIMap

Organization Active NPI

Boulder Medical Center, P.C.

  • Multi-Specialty Clinic/Center
  • Longmont, CO
National Provider Identifier
1144853904
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BOULDER MEDICAL CENTER, P.C.
Practice address
1551 Professional LN Unit 240
Longmont, CO 80501-6967
Phone
(303) 938-4710
NPI assigned
Feb 19, 2020
Last updated
Feb 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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

Authorized official

Name
Casandra Richards
Title
Credentialing Coordinator
Phone
(303) 440-3076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

1551 Professional LN Unit 240
Longmont, CO 80501-6967

Mailing address

2750 Broadway St
Boulder, CO 80304-3573
Phone (303) 440-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000512 CO Part B Supplier - Clinic/Group Practice 4183536204 Receives reassigned benefits from 99 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Erie, CO; Louisville, CO; Boulder, CO; Longmont, CO

Other NPIs on the same Medicare enrollment 5

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

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
06D2141535Boulder Medical Center1551 Professional Lane Ste 240, Longmont, CO 80501Provider-performed microscopyDec 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Geary Grantham MD4 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.

Locations

4745 Arapahoe Ave
Ste 200
Boulder, CO 80303
Phone (303) 938-4710

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1144853904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043573",
            "telephone_number": "303-440-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PROFESSIONAL LN UNIT 240",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016967",
            "telephone_number": "303-938-4710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "CASANDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "303-440-3076"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.