NPIMap

Organization Active NPI

Boulder Community Health Sports Medicine Imaging LLC

  • Radiology Clinic/Center
  • Boulder, CO
National Provider Identifier
1285017673
Registry record updated Aug 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
BOULDER COMMUNITY HEALTH SPORTS MEDICINE IMAGING LLC
Doing business as
Boulder Community Health Sports Medicine Imaging LLC
Practice address
2150 Stadium Dr FL 2
Suite 100
Boulder, CO 80309-0380
Phone
(303) 315-9901
Fax
(303) 315-9902
NPI assigned
Jul 2, 2015
Last updated
Aug 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2015

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

Authorized official

Name
Mr. William Munson
Title
V.P. and Chief Financial Officer
Phone
(303) 415-7433

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

2150 Stadium Dr FL 2
Suite 100
Boulder, CO 80309-0380

Mailing address

PO Box 9019
Boulder, CO 80301-9019
Phone (303) 938-3295

Other names 1

  • Boulder Community Health Sports Medicine Imaging LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151120000903 CO Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9830499003 Practice locations: Boulder, CO

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1285017673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9019",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803019019",
            "telephone_number": "303-938-3295",
            "fax_number": "303-440-2435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 STADIUM DR FL 2",
            "address_2": "SUITE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803090380",
            "telephone_number": "303-315-9901",
            "fax_number": "303-315-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER COMMUNITY HEALTH SPORTS MEDICINE IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-02",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "MUNSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "V.P. AND CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "303-415-7433",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Community Health Sports Medicine Imaging LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 6, 2015; 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.