Individual provider Active NPI

Ann L Mellott, MD

  • Hematology & Oncology Physician
  • Colorado Springs, CO
National Provider Identifier
1194704262
Registry record updated Dec 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
DR.0056052 Issued in CO
Practice address
4110 Briargate Pkwy
Suite 465
Colorado Springs, CO 80920-7835
Phone
(719) 365-6568
Fax
(719) 364-3582
NPI assigned
Jan 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 036096502 IL
Hematology & Oncology Physician 207RH0003X DR.0056052 CO Primary

Addresses

Primary practice location

4110 Briargate Pkwy
Suite 465
Colorado Springs, CO 80920-7835

Mailing address

4110 Briargate Pkwy
Suite 465
Colorado Springs, CO 80920-7835
Phone (719) 365-6568

Other identifiers 1

IdentifierTypeStateIssuer
036096502MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151230001444 CO Practitioner - Hematology/Oncology 7517859309 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

4050 Briargate Pkwy
Colorado Springs, CO 80920-7815

4080 Briargate Pkwy
Colorado Springs, CO 80920-7815
Phone (719) 365-6800

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022
  • Uchealth Grandview Hospital Hospital, Colorado Springs, CO, CCN 060130
  • Uchealth Pikes Peak Regional Hospital Hospital, Woodland Park, CO, CCN 061326
  • Parkview Medical Center, Inc Hospital, Pueblo, CO, CCN 060020
  • University of Colorado Hospital Authority Hospital, Aurora, CO, CCN 060024

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0056052COMDHematology & Oncology Physician
036096502ILMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Dec 8, 2015 Accepting new patients
Poudre Valley Medical Group, LLC Hematology & Oncology CurrentSince Dec 8, 2015 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

525 Bob Peters Grv
Ste 202
Colorado Springs, CO 80909
Phone (719) 365-6568

4050 Briargate Pkwy
Ste C1100
Colorado Springs, CO 80920
Phone (719) 364-6700

525 Bob Peters Grv
Ste 309
Colorado Springs, CO 80909
Phone (719) 365-6464

4110 Briargate Pkwy
Ste 465
Colorado Springs, CO 80920
Phone (719) 471-3930

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 54

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449532800000",
    "number": "1194704262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4110 BRIARGATE PKWY",
            "address_2": "SUITE 465",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207835",
            "telephone_number": "719-365-6568",
            "fax_number": "719-364-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 BRIARGATE PKWY",
            "address_2": "SUITE 465",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207835",
            "telephone_number": "719-365-6568",
            "fax_number": "719-364-3582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLOTT",
        "first_name": "ANN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-17",
        "last_updated": "2015-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IL",
            "license": "036096502",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CO",
            "license": "DR.0056052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036096502",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.