NPIMap

Organization Active NPI

Kallgren Dermatology

  • Dermatology Physician
  • Boulder, CO
National Provider Identifier
1275953689
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
179 Issued in CO
Legal business name
KALLGREN DERMATOLOGY
Practice address
3434 47TH Street
Suite 200
Boulder, CO 80301
Phone
(303) 444-8100
Fax
(303) 444-8113
NPI assigned
Apr 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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

Authorized official

Name
Ms. Susan Lynn Rancis, PA-C
Title
PA-C
Phone
(303) 444-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 179 CO Primary

Addresses

Primary practice location

3434 47TH Street
Suite 200
Boulder, CO 80301

Mailing address

3434 47TH Street
Suite 200
Boulder, CO 80301
Phone (303) 444-8100

National Provider Directory

National Provider Directory

Locations

3434 47th St
Ste 200
Boulder, CO 80301
Phone (303) 444-8100

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1398297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1275953689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 47TH STREET",
            "address_2": "SUITE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80301",
            "telephone_number": "303-444-8100",
            "fax_number": "303-444-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 47TH STREET",
            "address_2": "SUITE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80301",
            "telephone_number": "303-444-8100",
            "fax_number": "303-444-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALLGREN DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-24",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "RANCIS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PA-C",
        "authorized_official_telephone_number": "303-444-8100",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CO",
            "license": "179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.