NPIMap

Organization Active NPI

Western Infectious Disease Consultants, P.C.

  • Infectious Disease Physician
  • Broomfield, CO
National Provider Identifier
1225430325
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
WESTERN INFECTIOUS DISEASE CONSULTANTS, P.C.
Practice address
3303 W 144TH Ave
Suite 103
Broomfield, CO 80023-9464
Phone
(303) 425-9245
Fax
(303) 425-1378
NPI assigned
Sep 19, 2014
Last updated
Sep 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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

Authorized official

Name
Jeffrey A. Desjardin, M.D.NPI 1821191305
Title
Physician/ President
Phone
(303) 425-9245

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X NU Primary

Addresses

Primary practice location

3303 W 144TH Ave
Suite 103
Broomfield, CO 80023-9464

Mailing address

PO Box 1449
Wheat Ridge, CO 80034-1449
Phone (303) 425-9245

Other identifiers 2

IdentifierTypeStateIssuer
04007191MedicaidCO
C97408OtherMEDICARE GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318000931 CO Part B Supplier - Clinic/Group Practice 6305736786 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Longmont, CO; Wheat Ridge, CO; Broomfield, CO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Western Infectious Dise4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

3885 Upham St
Ste 200
Wheat Ridge, CO 80033
Phone (303) 425-9245

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1225430325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800341449",
            "telephone_number": "303-425-9245",
            "fax_number": "303-425-1378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 W 144TH AVE",
            "address_2": "SUITE 103",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800239464",
            "telephone_number": "303-425-9245",
            "fax_number": "303-425-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN INFECTIOUS DISEASE CONSULTANTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-19",
        "last_updated": "2014-09-19",
        "status": "A",
        "authorized_official_last_name": "DESJARDIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PHYSICIAN/ PRESIDENT",
        "authorized_official_telephone_number": "303-425-9245",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04007191",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "C97408",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; 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.