NPIMap

Organization Active NPI

The Pagosa Medical Group LLC

  • Surgery Physician
  • Pagosa SPGS, CO
National Provider Identifier
1255857660
Registry record updated Aug 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
THE PAGOSA MEDICAL GROUP LLC
Practice address
27B Talisman Dr Unit 3
Pagosa SPGS, CO 81147-8114
Phone
(970) 372-0456
Fax
(888) 974-3247
NPI assigned
Aug 17, 2017
Last updated
Aug 17, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2017

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

Authorized official

Name
Michelle Griego
Title
Communication Director
Phone
(970) 372-0456

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

27B Talisman Dr Unit 3
Pagosa SPGS, CO 81147-8114

Mailing address

27B Talisman Dr Unit 3
Pagosa SPGS, CO 81147-7914

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180515001936 CO Part B Supplier - Clinic/Group Practice 8729342936 Receives reassigned benefits from 15 practitioners
Practice locations: Pagosa Springs, CO

National Provider Directory

National Provider Directory

Locations

27B Talisman Dr
Unit 3
Pagosa Springs, CO 81147
Phone (970) 372-0456

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1502928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502928000000",
    "number": "1255857660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27B TALISMAN DR UNIT 3",
            "city": "PAGOSA SPGS",
            "state": "CO",
            "postal_code": "811477914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27B TALISMAN DR UNIT 3",
            "city": "PAGOSA SPGS",
            "state": "CO",
            "postal_code": "811478114",
            "telephone_number": "970-372-0456",
            "fax_number": "888-974-3247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PAGOSA MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-17",
        "last_updated": "2017-08-17",
        "status": "A",
        "authorized_official_last_name": "GRIEGO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "COMMUNICATION DIRECTOR",
        "authorized_official_telephone_number": "970-372-0456"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pagosa SPGS, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2017; 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.