NPIMap

Individual provider Active NPI

Brandon George Dmytruk, MD

  • Internal Medicine Physician
  • Pueblo, CO
National Provider Identifier
1235651514
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DR.0065006 Issued in CO
Practice address
400 W 16TH St
Pueblo, CO 81003-2745
Phone
(719) 584-4921
NPI assigned
Jul 8, 2017
Last updated
Jul 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR.0065006 CO Primary

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2745

Mailing address

5312 Outlook Blvd Apt 9302
Pueblo, CO 81008-1569
Phone (630) 995-6173

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200903002061 CO Practitioner - Hospitalist 2860766037 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4921

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0065006COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Single Specialty CurrentSince Jun 1, 2025 Accepting new patients
Pueblo Pathology Group, PC Single Specialty Current Accepting new patients
Poudre Valley Medical Group, LLC Single Specialty CurrentSince Jun 1, 2025 Accepting new patients
Parkview Medical Center, Inc. Past Accepting new patients
Parkview Medical Center, Inc. Past Accepting new patients

Locations

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1499472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1235651514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5312 OUTLOOK BLVD APT 9302",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081569",
            "telephone_number": "630-995-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DMYTRUK",
        "first_name": "BRANDON",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-08",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0065006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.