Ideal Family Medicine, LTD

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0992962 Issued in CO

Legal business name

IDEAL FAMILY MEDICINE, LTD

Practice address

1910 Lake Ave
Pueblo, CO 81004-3322

Phone

(719) 582-1489

Fax

(719) 434-9807

NPI assigned

Apr 11, 2017

Organization subpart

No

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

Authorized official

Name

Jade Bryant, FNP-BCNPI 1154861995

Title

Owner

Phone

(719) 582-1489

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jade Bryant, FNP-BC

  • Family Nurse Practitioner
  • Pueblo, CO
  • NPI 1154861995
  Medicare reassignment NPD Authorized official
• Danielle Marie Kizzie, FNP-C

  • Family Nurse Practitioner
  • Pueblo, CO
  • NPI 1780460592
  Medicare reassignment NPD

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1255865713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 E ABARR DR # 200",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810075436",
            "telephone_number": "719-582-1489",
            "fax_number": "719-434-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 LAKE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043322",
            "telephone_number": "719-582-1489",
            "fax_number": "719-434-9807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL FAMILY MEDICINE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-11",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "JADE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-582-1489",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "0992962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154861995",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• HV Pueblo South LLC
• Penelope Hyland
• Bryan A Hynes, M.D.
• Bailey Iannolo
• Georgette Ibanez
• Katelyn R Ihrig, RD
• Catherine J Iliff
• Janet Imblum
• Laura Imm
• Impact Counseling Consulting LLC

• Family Nurse Practitioner in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Family Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.