NPIMap

Individual provider Active NPI

Philip B Dattilo III, M.D.

  • Interventional Cardiology Physician
  • Fort Collins, CO
National Provider Identifier
1245452994
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
DR.0047426 Issued in CO
Practice address
2121 E Harmony Rd
Ste 100
Fort Collins, CO 80528-3400
Phone
(970) 221-1000
Fax
(970) 297-6844
NPI assigned
May 3, 2007
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR.0047426 CO
Cardiovascular Disease Physician 207RC0000X 47426 CO
Interventional Cardiology Physician 207RI0011X DR.0047426 CO Primary
Interventional Cardiology Physician 207RI0011X 28429 NE
Interventional Cardiology Physician 207RI0011X 10035A WY

Addresses

Primary practice location

2121 E Harmony Rd
Ste 100
Fort Collins, CO 80528-3400

Mailing address

2121 E Harmony Rd
Ste 100
Fort Collins, CO 80528-3400
Phone (970) 221-1000

Other identifiers 3

IdentifierTypeStateIssuer
P01479130OtherCORAILROAD
81987064MedicaidCO
1245452994MedicaidWY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, NE, WY3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20090707000184 CO Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3072664960 Reassigns benefits to 1 organization
I20150723008165 NE Practitioner - Interventional Cardiology 3072664960 Reassigns benefits to 1 organization
I20150813012273 WY Practitioner - Interventional Cardiology 3072664960 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Albert Einstein College of Medicine of Yeshiva University, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, shared by 2 NPIs, 2,425 clinicians

Practice addresses (Care Compare)

2101 Box Butte Ave
Alliance, NE 69301-4445
Phone (800) 459-4241

2121 E Harmony Rd
Unit 100 Uchmg Cardiology Fort Collins
Fort Collins, CO 80528-3401
Phone (970) 221-1000

3911 Ave B
Scottsbluff, NE 69361-4617
Phone (970) 482-3328

5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone (307) 634-1311

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47426COMDCardiovascular Disease Physician
DR.0047426COMDInterventional Cardiology Physician
28429NEMDInterventional Cardiology Physician
10035AWYMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Current Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Mar 30, 2015 Accepting new patients

Locations

11820 Destination Dr
Broomfield, CO 80021
Phone (303) 460-6000

1024 S Lemay Ave
#F1051
Fort Collins, CO 80524

1107 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 493-7442

2121 E Harmony Rd
Unit 100
Fort Collins, CO 80528
Phone (970) 663-3107

1900 16th St
Greeley, CO 80631
Phone (970) 350-2438

6767 29th St
Fl 3
Greeley, CO 80634
Phone (970) 652-2801

2500 Rocky Mountain Ave
Ste 100
Loveland, CO 80538
Phone (970) 624-1800

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

2101 Box Butte Ave
Alliance, NE 69301
Phone (308) 762-6660

2 W 42nd St
Ste 2200
Scottsbluff, NE 69361
Phone (308) 630-2626

3911 Avenue B
Scottsbluff, NE 69361
Phone (308) 630-2100

5050 Powderhouse Rd
Cheyenne, WY 82009
Phone (307) 634-1311

3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1245452994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-221-1000",
            "fax_number": "970-297-6844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-221-1000",
            "fax_number": "970-297-6844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATTILO",
        "first_name": "PHILIP",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0047426",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CO",
            "license": "47426",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CO",
            "license": "DR.0047426",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NE",
            "license": "28429",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WY",
            "license": "10035A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P01479130",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81987064",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245452994",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.