NPIMap

Organization Active NPI

Poudre Valley Medical Group, LLC

Doing business as UCHealth Medical Group

  • Physical Medicine & Rehabilitation Physician
  • Fort Collins, CO
National Provider Identifier
1205458221
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Doing business as
UCHealth Medical Group
Practice address
2315 E Harmony Rd Ste 110
Fort Collins, CO 80528-8623
Phone
(970) 482-4373
Fax
(970) 484-5682
NPI assigned
May 13, 2020
Last updated
Jun 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(970) 482-4373

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X

Addresses

Primary practice location

2315 E Harmony Rd Ste 110
Fort Collins, CO 80528-8623

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 482-4373

Other names 1

  • UCHealth Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Poudre Valley Med GR LLC283 organizations share this tax ID, including this one
Part of
Poudre Valley Med GR LLC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1205458221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-482-4373",
            "fax_number": "970-484-5682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 E HARMONY RD STE 110",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805288623",
            "telephone_number": "970-482-4373",
            "fax_number": "970-484-5682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2020-05-13",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "970-482-4373"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; 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.