NPIMap

Organization Active NPI

Colorado Retina Associates, PLLC

  • Medical Specialty Clinic/Center
  • Golden, CO
National Provider Identifier
1154955896
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
COLORADO RETINA ASSOCIATES, PLLC
Practice address
400 Indiana St Ste 310
Golden, CO 80401-5033
Phone
(303) 261-1600
Fax
(303) 261-1601
NPI assigned
Mar 2, 2020
Reactivated
Dec 2, 2022
Organization subpart
Yes
Parent organization
COLORADO RETINA ASSOCIATES, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

Name
Kylie Espinoza
Title
Credentialing Specialist
Phone
(303) 261-1600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207WX0107X
Uveitis and Ocular Inflammatory Disease (Ophthalmology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207WX0108X
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

400 Indiana St Ste 310
Golden, CO 80401-5033

Mailing address

PO Box 17949
Denver, CO 80217-0949
Phone (303) 261-1600

Other identifiers 1

IdentifierTypeStateIssuer
05958008MedicaidCO

Other names 1

  • Colorado Retina Associates, PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070125000355 CO Part B Supplier - Clinic/Group Practice 6002817566 Receives reassigned benefits from 15 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Denver, CO; Parker, CO; Littleton, CO; Lakewood, CO; Lafayette, CO; Golden, CO; Frisco, CO; Englewood, CO

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Colorado Retina Associates PLLC9 organizations share this tax ID, including this one
Part of
Colorado Retina Associates PLLC

Other organizations with this tax ID 8

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1154955896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17949",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802170949",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 INDIANA ST STE 310",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804015033",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO RETINA ASSOCIATES, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLORADO RETINA ASSOCIATES, PLLC",
        "enumeration_date": "2020-03-02",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "deactivation_date": "2022-06-14",
        "reactivation_date": "2022-12-02",
        "status": "A",
        "authorized_official_last_name": "ESPINOZA",
        "authorized_official_first_name": "KYLIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "303-261-1600"
    },
    "taxonomies": [
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0108X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology, Uveitis and Ocular Inflammatory Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05958008",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colorado Retina Associates, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Golden, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.