Active NPI
Portercare Adventist Health System
- Family Medicine Physician
- Castle Rock, CO
National Provider Identifier
1154766384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- PORTERCARE ADVENTIST HEALTH SYSTEM
- Practice address
- 2352 Meadows Blvd
Ste. 300
Castle Rock, CO 80109-8406 - Phone
- (720) 455-3750
- Fax
- (720) 455-3751
- NPI assigned
- May 1, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Angela Skinner
- Title
- Administrator Oma
- Phone
- (303) 643-0925
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
2352 Meadows Blvd
Ste. 300
Castle Rock, CO 80109-8406
Mailing address
PO Box 911244
Denver, CO 80291-1244
Phone (303) 643-1100
Other names 1
- Ridgeline Family Medicine At The Meadows
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090115000327 | CO | Part B Supplier - Clinic/Group Practice | 0941110886 |
Receives reassigned benefits from 869 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367366400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1443052800000",
"number": "1154766384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 911244",
"city": "DENVER",
"state": "CO",
"postal_code": "802911244",
"telephone_number": "303-643-1100",
"fax_number": "303-643-1176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2352 MEADOWS BLVD",
"address_2": "STE. 300",
"city": "CASTLE ROCK",
"state": "CO",
"postal_code": "801098406",
"telephone_number": "720-455-3750",
"fax_number": "720-455-3751"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PORTERCARE ADVENTIST HEALTH SYSTEM",
"organizational_subpart": "NO",
"enumeration_date": "2013-05-01",
"last_updated": "2015-09-24",
"status": "A",
"authorized_official_last_name": "SKINNER",
"authorized_official_first_name": "ANGELA",
"authorized_official_title_or_position": "ADMINISTRATOR OMA",
"authorized_official_telephone_number": "303-643-0925"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Ridgeline Family Medicine At The Meadows",
"code": "3",
"type": "Doing Business As"
}
]
}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 Sep 24, 2015; 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.