Portercare Adventist Health System

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

PORTERCARE ADVENTIST HEALTH SYSTEM

Practice address

4350 Limelight Ave Ste 100
Castle Rock, CO 80109-8034

Phone

(720) 330-1390

Fax

(720) 995-5206

NPI assigned

May 4, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Jason Tacha

Title

Coo

Phone

(303) 304-7752

Specialties & licenses 1

Addresses

Other names 2

• AdventHealth Medical Group Sports Medicine at Castle Rock Doing business as
• HealthFit Sports Medicine Castle Rock Other name

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Practitioners 6

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

• Amanda Christine Alba, CNM, WHNP-BC

  • Advanced Practice Midwife
  • Aurora, CO
  • NPI 1073877486
  NPD
• Julie Hammond, PA-C

  • Medical Physician Assistant
  • Longmont, CO
  • NPI 1619305695
  NPD
• John Lawrence Hudson, MD

  • Neurological Surgery Physician
  • Lakewood, CO
  • NPI 1184634537
  NPD
• Kaddy Barrow McIntyre, PA-C

  • Physician Assistant
  • Louisville, CO
  • NPI 1417373077
  NPD
• Madison Peterson, PA-C

  • Physician Assistant
  • Castle Rock, CO
  • NPI 1235781295
  NPD
• Elizabeth Amney Rowan, PA-C

  • Medical Physician Assistant
  • Colorado Springs, CO
  • NPI 1417385428
  NPD

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

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1235828294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713425",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606774325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 LIMELIGHT AVE STE 100",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801098034",
            "telephone_number": "720-330-1390",
            "fax_number": "720-995-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTERCARE ADVENTIST HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-04",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "TACHA",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "303-304-7752",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdventHealth Medical Group Sports Medicine at Castle Rock",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HealthFit Sports Medicine Castle Rock",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System
• Portercare Adventist Health System

• All providers in Castle Rock, CO
• Sports Medicine (Family Medicine) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.