Individual provider Active NPI

Kathy Sue Lynch, M.D.

  • Family Medicine Physician
  • Cortez, CO
National Provider Identifier
1245483478
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
50521 Issued in CO
Practice address
118 N Chestnut St
Cortez, CO 81321-3104
Phone
(970) 564-9777
Fax
(970) 564-8833
NPI assigned
Oct 31, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD 60140024 WA
Family Medicine Physician 207Q00000X 50521 CO Primary

Addresses

Primary practice location

118 N Chestnut St
Cortez, CO 81321-3104

Mailing address

118 N Chestnut St
Cortez, CO 81321-3104
Phone (970) 564-9777

Other identifiers 1

IdentifierTypeStateIssuer
59983388MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20171010002214 TX Practitioner - Family Practice 9032234034 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS IHS Phoenix AreaGroup PAC ID 2668649567, 72 clinicians

Practice addresses (Care Compare)

200 W Hospital Dr
860 Whiteriver Indian
Whiteriver, AZ 85941-0860
Phone 92833849113532

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 60140024WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS IHS Phoenix Area CurrentSince Sep 19, 2017 Accepting new patients
DHHS IHS Phoenix Area Current Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Nov 2, 2019 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Nov 2, 2019 Accepting new patients

Locations

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

Organizations & group practices 4

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 2

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": "1225411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322438400000",
    "number": "1245483478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 N CHESTNUT ST",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813213104",
            "telephone_number": "970-564-9777",
            "fax_number": "970-564-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 N CHESTNUT ST",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813213104",
            "telephone_number": "970-564-9777",
            "fax_number": "970-564-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYNCH",
        "first_name": "KATHY",
        "middle_name": "SUE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-31",
        "last_updated": "2011-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD 60140024",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "50521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59983388",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cortez, CO

Sources for this page

Verify at the official NPI Registry.