Individual provider Active NPI

Breanna Tomlin, MD

  • Obstetrics & Gynecology Physician
  • Boulder, CO
National Provider Identifier
1265878631
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
DR.0058836 Issued in CO
Practice address
2525 13TH St
Boulder, CO 80304-4104
Phone
(303) 449-6050
Fax
(720) 565-4132
NPI assigned
May 13, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X BP10046469 TX
Obstetrics & Gynecology Physician 207V00000X DR.0058836 CO Primary

Addresses

Primary practice location

2525 13TH St
Boulder, CO 80304-4104

Mailing address

1735 S Public Rd Ste 203
Lafayette, CO 80026-7093
Phone (303) 665-3036

Other practice location 1

1441 N Beckley Ave
Dallas, TX 75203-1201
Phone (214) 947-2331

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address breanna.tomlin.p4@direct.clinicafamilyhealth.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20170808002976 CO Practitioner - Obstetrics/Gynecology 3870721954 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0058836COMDObstetrics & Gynecology Physician
BP10046469TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinica Campesina Family Health Services CurrentSince Aug 14, 2017 Accepting new patients
Clinica Campesina Family Health Services CurrentSince Aug 14, 2017 Accepting new patients
Portercare Adventist Health System Past Accepting new patients
Clinica Campesina Family Health Services Past Accepting new patients

Locations

2525 13th St
Boulder, CO 80304
Phone (303) 449-6050

1735 S Public Rd
Lafayette, CO 80026
Phone 30366530361061

1345 Plaza Ct N
Ste 1A
Lafayette, CO 80026
Phone (303) 665-2962

1735 S Public Rd
Ste 203
Lafayette, CO 80026

100 Health Park Dr
Louisville, CO 80027
Phone (303) 673-1000

Interoperability endpoints

  • Direct secure messaging: breanna.tomlin.p4@direct.clinicafamilyhealth.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1368403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1265878631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 S PUBLIC RD STE 203",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267093",
            "telephone_number": "303-665-3036",
            "fax_number": "303-665-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 13TH ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803044104",
            "telephone_number": "303-449-6050",
            "fax_number": "720-565-4132"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1441 N Beckley Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752031201",
            "country_code": "US",
            "telephone_number": "214-947-2331",
            "fax_number": "214-947-6753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TOMLIN",
        "first_name": "BREANNA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-13",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "BP10046469",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CO",
            "license": "DR.0058836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "breanna.tomlin.p4@direct.clinicafamilyhealth.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "NextGen EHR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "2525 13th St",
            "city": "Boulder",
            "state": "CO",
            "country_code": "US",
            "postal_code": "803044104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.