NPIMap

Individual provider Active NPI

Lisa M Keith, ARNP

  • Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1194776013
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
100283 Issued in CO
Practice address
175 S Union Blvd Ste 300
Colorado Springs, CO 80910-3126
Phone
(719) 364-5005
Fax
(719) 365-9911
NPI assigned
May 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 100283 CO Primary

Addresses

Primary practice location

175 S Union Blvd Ste 300
Colorado Springs, CO 80910-3126

Mailing address

8890 N Union Blvd Ste 170
Colorado Springs, CO 80920-2701
Phone (719) 364-5005

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061016000094 CO Practitioner - Nurse Practitioner 5092628636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
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)

8890 N Union Blvd
Suite 170 Uchmg Primary Care Briargate
Colorado Springs, CO 80920-2701
Phone (719) 364-5005

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
551HIMDAcupuncturist
100283COMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Mar 12, 2018 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Mar 12, 2018 Accepting new patients

Locations

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

8890 N Union Blvd
Ste 200
Colorado Springs, CO 80920
Phone (719) 548-0700

175 S Union Blvd
Ste 300
Colorado Springs, CO 80910
Phone (719) 365-6363

175 S Union Blvd
Ste 310
Colorado Springs, CO 80910
Phone (719) 365-6363

8890 N Union Blvd
Ste 220
Colorado Springs, CO 80920
Phone (719) 574-9191

8890 N Union Blvd
Ste 170
Colorado Springs, CO 80920
Phone (719) 364-5005

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

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

Organizations & group practices 2

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1194776013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8890 N UNION BLVD STE 170",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809202701",
            "telephone_number": "719-364-5005",
            "fax_number": "719-365-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 S UNION BLVD STE 300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809103126",
            "telephone_number": "719-364-5005",
            "fax_number": "719-365-9911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITH",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "100283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.