NPIMap

Organization Active NPI

Castle Valley Children'S Clinic

  • Primary Care Clinic/Center
  • Carbondale, CO
National Provider Identifier
1285282137
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CASTLE VALLEY CHILDREN'S CLINIC
Practice address
2615 Dolores Way Unit 103
Carbondale, CO 81623-2238
Phone
(970) 984-3333
Fax
(970) 984-0293
NPI assigned
Sep 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2020

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

Authorized official

Name
Jo Ellyn Bradley
Title
Practice Manager
Phone
(970) 984-3333

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

2615 Dolores Way Unit 103
Carbondale, CO 81623-2238

Mailing address

820 Castle Valley Blvd Ste 204
New Castle, CO 81647-9453
Phone (970) 984-3333

Other identifiers 1

IdentifierTypeStateIssuer
08189731MedicaidCO

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
06D2076137Castle Valley Children'S Clinic2615 Dolores Way Unit 103, Carbondale, CO 81623Certificate of waiverApr 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
Castle Valley Children'S Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1567468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1285282137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 CASTLE VALLEY BLVD STE 204",
            "city": "NEW CASTLE",
            "state": "CO",
            "postal_code": "816479453",
            "telephone_number": "970-984-3333",
            "fax_number": "970-984-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 DOLORES WAY UNIT 103",
            "city": "CARBONDALE",
            "state": "CO",
            "postal_code": "816232238",
            "telephone_number": "970-984-3333",
            "fax_number": "970-984-0293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASTLE VALLEY CHILDREN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-03",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JO",
        "authorized_official_middle_name": "ELLYN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "970-984-3333"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08189731",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.