NPIMap

Organization Active NPI

Boulder Gynecology & Minimally Invasive Surgery

  • Gynecology Physician
  • Boulder, CO
National Provider Identifier
1194071605
Registry record updated Aug 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
43874 Issued in CO
Legal business name
BOULDER GYNECOLOGY & MINIMALLY INVASIVE SURGERY
Practice address
4800 Riverbend Rd
Suite 200
Boulder, CO 80301-2636
Phone
(720) 382-2621
Fax
(720) 382-2625
NPI assigned
Aug 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2012

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

Authorized official

Name
Lisa Lepine, M.D.NPI 1750342234
Title
President/Owner
Phone
(720) 382-2621

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X 43874 CO Primary

Addresses

Primary practice location

4800 Riverbend Rd
Suite 200
Boulder, CO 80301-2636

Mailing address

4800 Riverbend Rd
Suite 200
Boulder, CO 80301-2636
Phone (720) 382-2621

Other identifiers 2

IdentifierTypeStateIssuer
48574279MedicaidCO
802492OtherCOMEDICARE ID - TYPE UNSPECIFIED

Other names 1

  • Boulder Gynecology Other name

National Provider Directory

National Provider Directory

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": "1343865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343865600000",
    "number": "1194071605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 RIVERBEND RD",
            "address_2": "SUITE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012636",
            "telephone_number": "720-382-2621",
            "fax_number": "720-382-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 RIVERBEND RD",
            "address_2": "SUITE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012636",
            "telephone_number": "720-382-2621",
            "fax_number": "720-382-2625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER GYNECOLOGY & MINIMALLY INVASIVE SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-02",
        "last_updated": "2012-08-02",
        "status": "A",
        "authorized_official_last_name": "LEPINE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "720-382-2621",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "CO",
            "license": "43874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48574279",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "802492",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Gynecology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; 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.