NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

Doing business as Wheat Ridge Clinic - Neurology

  • Neurology Physician
  • Wheat Ridge, CO
National Provider Identifier
1225745458
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Doing business as
Wheat Ridge Clinic - Neurology
Practice address
3455 Lutheran Pkwy Ste 285
Wheat Ridge, CO 80033-6034
Phone
(303) 403-6720
Fax
(720) 616-6983
NPI assigned
Oct 27, 2022
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Jon McDaniel
Title
VP Finance
Phone
(303) 272-0231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

3455 Lutheran Pkwy Ste 285
Wheat Ridge, CO 80033-6034

Mailing address

500 Eldorado Blvd Ste 4300
Broomfield, CO 80021-3564
Phone (303) 272-0566

Other names 1

  • Wheat Ridge Clinic - Neurology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150106000131 CO Part B Supplier - Clinic/Group Practice 0840513552 Receives reassigned benefits from 1,361 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Intermountain Front Range I

Practitioners & affiliated clinicians

Practitioners 5

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": "1666828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1225745458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 4300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213564",
            "telephone_number": "303-272-0566",
            "fax_number": "303-272-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 LUTHERAN PKWY STE 285",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336034",
            "telephone_number": "303-403-6720",
            "fax_number": "720-616-6983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2022-10-27",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wheat Ridge Clinic - Neurology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheat Ridge, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.