NPIMap

Organization Active NPI

Boulder Valley Gastroenterology Inc.

Doing business as Gastroenterology of the Rockies

  • Gastroenterology Physician
  • Longmont, CO
National Provider Identifier
1184210312
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
BOULDER VALLEY GASTROENTEROLOGY INC.
Doing business as
Gastroenterology of the Rockies
Practice address
1551 Professional LN Unit 290
Longmont, CO 80501-6970
Phone
(303) 604-5000
NPI assigned
Dec 11, 2020
Last updated
Dec 11, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BOULDER VALLEY GASTROENTEROLOGY INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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

Authorized official

Name
Daus MahnkeNPI 1306878566
Title
MD
Phone
(303) 604-5000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

1551 Professional LN Unit 290
Longmont, CO 80501-6970

Mailing address

382 S Arthur Ave
Louisville, CO 80027-3094

Other names 1

  • GASTROENTEROLOGY OF THE ROCKIES Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130001035 CO Part B Supplier - Clinic/Group Practice 4688577174 Receives reassigned benefits from 76 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lakewood, CO; Littleton, CO; Longmont, CO; Northglenn, CO; Broomfield, CO; Denver, CO; Boulder, CO; Aurora, CO…

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Boulder Valley Gastroenterology Inc7 organizations share this tax ID, including this one
Part of
Boulder Valley Gastroenterology Inc

Other organizations with this tax ID 6

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.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1184210312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 S ARTHUR AVE",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800273094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PROFESSIONAL LN UNIT 290",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016970",
            "telephone_number": "303-604-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER VALLEY GASTROENTEROLOGY INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOULDER VALLEY GASTROENTEROLOGY INC.",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "MAHNKE",
        "authorized_official_first_name": "DAUS",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "303-604-5000"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GASTROENTEROLOGY OF THE ROCKIES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 11, 2020; 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.