Active NPI
C. Glen Ferguson, D.O.
- Anesthesiology Physician
- Pueblo, CO
National Provider Identifier
1245330141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 17205
- Practice address
- 1615 Bonforte Blvd
Pueblo, CO 81001-1602 - Phone
- (719) 296-5840
- Fax
- (719) 542-0746
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 17205 | CO | Primary |
Addresses
Primary practice location
1615 Bonforte Blvd
Pueblo, CO 81001-1602
Mailing address
1615 Bonforte Blvd
Pueblo, CO 81001-1602
Phone (719) 296-5840
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17205 | Other | CO | COLORADO STATE LICENSE |
| 94559040 | Medicaid | CO | |
| 01172055 | Medicaid | CO | |
| FE03792 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C. Glen Ferguson D.O. P.C. | Anesthesiology | Past | Accepting new patients |
| Physician Anesthesia of Pueblo, PC | Anesthesiology | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.healthtogo.me/fhir/r4/criterions.phyanesthesia
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Anesthesiology Physician
- Pueblo, CO
- NPI 1710105333
-
- Anesthesiology Physician
- Pueblo, CO
- NPI 1770631202
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1245330141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1615 BONFORTE BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011602",
"telephone_number": "719-296-5840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 BONFORTE BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011602",
"telephone_number": "719-296-5840",
"fax_number": "719-542-0746"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERGUSON",
"first_name": "C.",
"middle_name": "GLEN",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CO",
"license": "17205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO STATE LICENSE",
"identifier": "17205",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "94559040",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01172055",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "FE03792",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.