NPIMap

Organization Active NPI

Pediatric Partners of the Southwest P.C.

  • Pediatrics Physician
  • Bayfield, CO
National Provider Identifier
1205588100
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.
Practice address
658 S East St Ste 301
Bayfield, CO 81122-5020
Phone
(970) 375-0100
NPI assigned
Jan 21, 2022
Last updated
Jan 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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

Authorized official

Name
Alexander Schackel
Title
Practice Administrator
Phone
(970) 375-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

658 S East St Ste 301
Bayfield, CO 81122-5020

Mailing address

810 E 3Rd St Unit 301
Durango, CO 81301-5760
Phone (970) 375-0100

Other identifiers 1

IdentifierTypeStateIssuer
948843159MedicaidCO

Other names 1

  • Pediatric Partners of the Southwest P.C. Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2155221Pediatric Partners of the Southwest658 S East St, Bayfield, CO 81122Certificate of waiverSep 24, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Partners of the Southwest PC4 organizations share this tax ID, including this one
Part of
Pediatric Partners of the Southwest PC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

810 E 3rd St
Unit 301
Durango, CO 81301
Phone (970) 375-0100

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1205588100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 E 3RD ST UNIT 301",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813015760",
            "telephone_number": "970-375-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "658 S EAST ST STE 301",
            "city": "BAYFIELD",
            "state": "CO",
            "postal_code": "811225020",
            "telephone_number": "970-375-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC PARTNERS OF THE SOUTHWEST P.C.",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "SCHACKEL",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "970-375-0100"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "948843159",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Partners of the Southwest P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bayfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.