NPIMap

Organization Active NPI

Poudre Valley Medical Group, LLC

  • Neurological Surgery Physician
  • Fort Collins, CO
National Provider Identifier
1164023313
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Practice address
1107 S Lemay Ave Ste 240
Fort Collins, CO 80524-3959
Phone
(970) 495-7421
Fax
(970) 495-7424
NPI assigned
Nov 4, 2020
Organization subpart
Yes
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

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

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(970) 495-7421

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X Primary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X

Addresses

Primary practice location

1107 S Lemay Ave Ste 240
Fort Collins, CO 80524-3959

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 495-7421

Other names 2

  • UCHealth Medical Group Doing business as
  • UCHealth Brain and Spine Clinic - Fort Collins Other name

National Provider Directory

National Provider Directory
Tax ID family
Poudre Valley Medical LLC282 organizations share this tax ID, including this one
Part of
Poudre Valley Medical LLC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1164023313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-495-7421",
            "fax_number": "970-495-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 S LEMAY AVE STE 240",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805243959",
            "telephone_number": "970-495-7421",
            "fax_number": "970-495-7424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2020-11-04",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "970-495-7421"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHealth Brain and Spine Clinic - Fort Collins",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.