NPIMap

Organization Active NPI

Pueblo Radiological Group, P.C.

  • Radiology Clinic/Center
  • Pueblo, CO
National Provider Identifier
1164023131
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
PUEBLO RADIOLOGICAL GROUP, P.C.
Practice address
4112 Outlook Blvd Ste 37
Pueblo, CO 81008-1667
Phone
(719) 562-6300
Fax
(719) 542-7019
NPI assigned
Nov 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Authorized official

Name
Robin L Boyer
Title
Auth Rep / Director of Operations
Phone
(970) 663-2742

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

4112 Outlook Blvd Ste 37
Pueblo, CO 81008-1667

Mailing address

PO Box 7693
Loveland, CO 80537-0693
Phone (970) 663-2742

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031211001035 CO Part B Supplier - Clinic/Group Practice 5597661272 Receives reassigned benefits from 11 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Canon City, CO; Walsenburg, CO; Pueblo, CO; Colorado Springs, CO

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Pueblo Radiological Group PC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1164023131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7693",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370693",
            "telephone_number": "970-663-2742",
            "fax_number": "970-342-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 OUTLOOK BLVD STE 37",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081667",
            "telephone_number": "719-562-6300",
            "fax_number": "719-542-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO RADIOLOGICAL GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-05",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "AUTH REP / DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "970-663-2742"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.