Four Mile Creek Health

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FOUR MILE CREEK HEALTH

Practice address

3434 47TH St Ste 225
Boulder, CO 80301-1880

Phone

(703) 850-1533

Fax

(303) 586-7592

NPI assigned

Dec 3, 2024

Organization subpart

No

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

Authorized official

Name

Radford Fagan

Title

Vice President

Phone

(720) 792-2852

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

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

• Landrey Fagan, MD

  • Family Medicine Physician
  • Boulder, CO
  • NPI 1548423817
  Medicare reassignment Care Compare group NPD
• Fabiana Monte Alegre Olmos Fernandez, MD

  • Internal Medicine Physician
  • Boulder, CO
  • NPI 1588288013
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1225854425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 47TH ST STE 225",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011880",
            "telephone_number": "703-850-1533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 47TH ST STE 225",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011880",
            "telephone_number": "703-850-1533",
            "fax_number": "303-586-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR MILE CREEK HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-03",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "RADFORD",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "720-792-2852"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foundational Wellness, PLLC
• Fountain Wellness, LLC
• Jeff Fountain, D.C.
• Guillaume Fouque, P.T.
• Four Elements Counseling LLC
• Sydney Fouts-Hyatt
• Kristin Oliver Fowler, COTA
• Nancy Fowler, M.A.
• Daniel Fox, MA, LPC
• Jenny R Fox, MD

• Family Medicine Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.