Pueblo Sports and Family Medicine PLLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

543004 Issued in CO

Legal business name

PUEBLO SPORTS AND FAMILY MEDICINE PLLC

Practice address

1315 Fortino Blvd Ste C
Pueblo, CO 81008-1981

Phone

(719) 544-2740

NPI assigned

Apr 16, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Rakesh Khosla, MDNPI 1952466336

Title

President

Phone

(719) 544-2740

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rakesh Kumar Khosla, M.D.

  • Family Medicine Physician
  • Pueblo, CO
  • NPI 1952466336

  Sports Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Emily Allen Owen

  • Physician Assistant
  • Colorado Springs, CO
  • NPI 1457236499
  Medicare reassignment Care Compare group NPD
• Kali Mae Mendoza-Werner, PAC

  • Physician Assistant
  • La Junta, CO
  • NPI 1205826013
  Medicare reassignment
• Shyanna Anness Neu, PA-C

  • Physician Assistant
  • Pueblo, CO
  • NPI 1063176881
  Medicare reassignment
• Josey Schnaufer, PA-C

  • Physician Assistant
  • Pueblo, CO
  • NPI 1306389853
  Medicare reassignment

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524355200000",
    "number": "1225525132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 FORTINO BLVD STE C",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081981",
            "telephone_number": "719-544-2740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 FORTINO BLVD STE C",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081981",
            "telephone_number": "719-544-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO SPORTS AND FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-22",
        "status": "A",
        "authorized_official_last_name": "KHOSLA",
        "authorized_official_first_name": "RAKESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-544-2740",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CO",
            "license": "543004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA NUMBER",
            "identifier": "0004910",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1268788",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pueblo Rehab & Orthopedic Therapy LLC (PRO Therapy)
• Pueblo School District 60
• Pueblo Senior Counseling LLC
• Pueblo SNF Healthcare, LLC (Atlas Post Acute)
• Pueblo Speech and Neurological Rehabilitation Center
• Pueblo Vascular Diagnostics, Inc
• Pueblo Womens Center
• Pueblo Womens Center, LLC
• Miranda Puente, BSW
• Kaitlyn Pullara

• Sports Medicine (Family Medicine) Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Sports Medicine (Family Medicine) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.