Individual provider Active NPI

John Carl Nielson, FNP

  • Family Nurse Practitioner
  • Thornton, CO
National Provider Identifier
1205152907
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
103015 Issued in CO
Practice address
1551 Milky Way
Thornton, CO 80260-4713
Phone
(303) 426-4525
Fax
(303) 428-6381
NPI assigned
Apr 20, 2010
Last updated
Sep 17, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 103015 CO Primary

Addresses

Primary practice location

1551 Milky Way
Thornton, CO 80260-4713

Mailing address

10900 W 44TH Ave Unit 200
Wheat Ridge, CO 80033-2742
Phone (720) 923-1239

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160302001271 CO Practitioner - Nurse Practitioner 9335445238

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
103015COMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Dermatology Clinic, PC CurrentSince Mar 1, 2017 Accepting new patients

Locations

3575 Broadway St
Boulder, CO 80304
Phone (303) 449-0933

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1205152907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10900 W 44TH AVE UNIT 200",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800332742",
            "telephone_number": "720-923-1239",
            "fax_number": "303-284-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 MILKY WAY",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802604713",
            "telephone_number": "303-426-4525",
            "fax_number": "303-428-6381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSON",
        "first_name": "JOHN",
        "middle_name": "CARL",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-20",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "103015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thornton, CO

Sources for this page

Verify at the official NPI Registry.