NPIMap

Organization Active NPI

Colorado Surgical Service PC

Doing business as Surgical Specialists of Colorado

  • Surgery Physician
  • Basalt, CO
National Provider Identifier
1245837376
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
COLORADO SURGICAL SERVICE PC
Doing business as
Surgical Specialists of Colorado
Practice address
1450 E Valley Rd Unit 105
Basalt, CO 81621-8352
Phone
(970) 429-4267
NPI assigned
Oct 1, 2020
Last updated
Jan 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Authorized official

Name
Lars Ankersen
Title
Cfo
Phone
(720) 996-0780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1450 E Valley Rd Unit 105
Basalt, CO 81621-8352

Mailing address

4350 Wadsworth Blvd Ste 401
Wheat Ridge, CO 80033-4638
Phone (720) 996-0780

Other names 1

  • Surgical Specialists of Colorado Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304000186 CO Part B Supplier - Clinic/Group Practice 7416844311 Receives reassigned benefits from 20 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Basalt, CO; Golden, CO; Highlands Ranch, CO; Wheat Ridge, CO

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Colorado Surgical Service2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10103 Ridgegate Pkwy
Ste 211
Lone Tree, CO 80124
Phone (720) 282-0560

NPI Registry JSON

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609977600000",
    "number": "1245837376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 WADSWORTH BLVD STE 401",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334638",
            "telephone_number": "720-996-0780",
            "fax_number": "303-392-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 E VALLEY RD UNIT 105",
            "city": "BASALT",
            "state": "CO",
            "postal_code": "816218352",
            "telephone_number": "970-429-4267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO SURGICAL SERVICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-01",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A",
        "authorized_official_last_name": "ANKERSEN",
        "authorized_official_first_name": "LARS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "720-996-0780"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgical Specialists of Colorado",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surgical Specialists of Colorado",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Basalt, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; 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.