NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

  • Cardiovascular Disease Physician
  • Golden, CO
National Provider Identifier
1275375339
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Practice address
400 Indiana St Ste 390
Golden, CO 80401-5067
Phone
(303) 716-8027
Fax
(303) 238-5258
NPI assigned
Jun 10, 2024
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Jon McDaniel
Title
VP Finance
Phone
(032) 720-0231

Corporate family (same tax ID) 24

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

Practitioners 8

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2301680Intermountain Health Heart and Vascular400 Indiana St, Suite 390, Golden, CO 80401Certificate of waiverMar 28, 2028

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20150106000131 CO Part B Supplier - Clinic/Group Practice 0840513552 Receives reassigned benefits from 1,361 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Medical Group Denver LLC (121 organizations share this tax ID)
Part of
Lutheran Medical Center

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

NPPES NPI Registry

Primary practice location

400 Indiana St Ste 390
Golden, CO 80401-5067

Mailing address

500 Eldorado Blvd Ste 4300
Broomfield, CO 80021-3564
Phone (303) 272-0566

Other names 1

NPPES NPI Registry
  • Intermountain Health Heart & Vascular - New West Golden Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 10, 2024.

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1275375339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 4300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213564",
            "telephone_number": "303-272-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 INDIANA ST STE 390",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804015067",
            "telephone_number": "303-716-8027",
            "fax_number": "303-238-5258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "032-720-0231"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intermountain Health Heart & Vascular - New West Golden",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Golden, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.