Individual provider Active NPI

Clifton Etienne, MD

  • Family Medicine Physician
  • Westminster, CO
National Provider Identifier
1245425289
Registry record updated Feb 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
45991 Issued in CO
Practice address
12201 Pecos St
Unit #500
Westminster, CO 80234-3888
Phone
(303) 457-4497
Fax
(303) 254-4369
NPI assigned
Sep 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 45991 CO Primary

Addresses

Primary practice location

12201 Pecos St
Unit #500
Westminster, CO 80234-3888

Mailing address

12201 Pecos St
Suite 500
Westminster, CO 80234-3888
Phone (303) 457-4497

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071003000596 CO Practitioner - Family Practice 1951496181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Westmed Primary CareGroup PAC ID 3678464740, 6 clinicians

Practice addresses (Care Compare)

12201 Pecos St
Suite 500
Westminster, CO 80234-3888

12201 Pecos St
Suite 500
Westminster, CO 80234-3995
Phone (303) 457-4497

Hospital & facility affiliations

  • HCA Healthone Mountain Ridge Hospital, Thornton, CO, CCN 060065

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45991COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Westmed Primary Care Family Medicine CurrentSince Jul 2, 2012 Accepting new patients

Locations

12201 Pecos St
Ste 500
Westminster, CO 80234
Phone (303) 457-4497

8601 Turnpike Dr
Unit 200
Westminster, CO 80031
Phone (303) 428-7449

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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": "1189555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329955200000",
    "number": "1245425289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12201 PECOS ST",
            "address_2": "SUITE 500",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802343888",
            "telephone_number": "303-457-4497",
            "fax_number": "303-540-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12201 PECOS ST",
            "address_2": "UNIT #500",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802343888",
            "telephone_number": "303-457-4497",
            "fax_number": "303-254-4369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETIENNE",
        "first_name": "CLIFTON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-12",
        "last_updated": "2012-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "45991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, CO

Sources for this page

Verify at the official NPI Registry.