NPIMap

Organization Active NPI

Diversified Radiology of Colorado, Inc

  • Diagnostic Radiology Physician
  • Lakewood, CO
National Provider Identifier
1205923596
Registry record updated Apr 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
DIVERSIFIED RADIOLOGY OF COLORADO, INC
Practice address
1746 Cole Blvd
Suite 150
Lakewood, CO 80401-3208
Phone
(303) 914-8800
Fax
(303) 716-3777
NPI assigned
Oct 6, 2006
Last updated
Apr 30, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2019

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

Authorized official

Name
Tracy L. Walker
Title
Cfo
Phone
(303) 914-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

1746 Cole Blvd
Suite 150
Lakewood, CO 80401-3208

Mailing address

1746 Cole Blvd
Suite 150
Lakewood, CO 80401-3208
Phone (303) 914-8800

Other identifiers 1

IdentifierTypeStateIssuer
04004826MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, FL, CA, NY, GA, NJ, MT, WA, TX, NM, UT11 enrollments

Enrollment records 11

Enrollment IDStateProvider typePAC IDDetails
O20031105000319 CO Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 74 practitioners
Practice locations: Frisco, CO; Franktown, CO; Fort Collins, CO; Evergreen, CO; Englewood, CO; Edwards, CO; Eagle, CO; Dillon, CO…
O20181116000079 FL Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 3 practitioners
Practice locations: Fort Lauderdale, FL; Key Biscayne, FL; Pensacola, FL
O20201211002422 CA Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 3 practitioners
Practice locations: Huntington Beach, CA; La Jolla, CA; San Rafael, CA
O20210128002763 NY Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 1 practitioner
Practice locations: Mount Vernon, NY
O20210802003321 GA Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 1 practitioner
Practice locations: Atlanta, GA
O20220616002827 NJ Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 1 practitioner
Practice locations: Teaneck, NJ
O20221021001062 MT Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 13 practitioners
Practice locations: Butte, MT
O20230214001775 WA Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 1 practitioner
Practice locations: Seattle, WA
O20230524002522 TX Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 3 practitioners
Practice locations: Houston, TX; Katy, TX; San Antonio, TX
O20240823000369 NM Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM
O20250314002560 UT Part B Supplier - Clinic/Group Practice 0143132316 Receives reassigned benefits from 1 practitioner
Practice locations: Salt Lake City, UT

National Provider Directory

National Provider Directory

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Locations

10405 Martin Luther King Blvd
Ste 130
Denver, CO 80238

1800 N Williams St
Denver, CO 80218
Phone (303) 388-4876

4384 Tennyson St
Unit 3J
Denver, CO 80212

377 Sylvan Lake Rd
Ste 130
Eagle, CO 81631
Phone (970) 326-6715

1746 Cole Blvd
Lakewood, CO 80401
Phone (443) 388-3948

3900 S Wadsworth Blvd
#210
Lakewood, CO 80235

9191 Grant St
Ste B40
Thornton, CO 80229

1499 W 120th Ave
Ste 100
Westminster, CO 80234
Phone (303) 280-8578

5970 Berryhill Rd
Milton, FL 32570

400 S Clark St
Ste 300
Butte, MT 59701

Practitioners & affiliated clinicians

Practitioners 204

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.

View all 204

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556582400000",
    "number": "1205923596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 COLE BLVD",
            "address_2": "SUITE 150",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "804013208",
            "telephone_number": "303-914-8800",
            "fax_number": "303-716-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1746 COLE BLVD",
            "address_2": "SUITE 150",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "804013208",
            "telephone_number": "303-914-8800",
            "fax_number": "303-716-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED RADIOLOGY OF COLORADO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2019-04-30",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-914-8800"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04004826",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.