NPIMap

Individual provider Active NPI

Nicole Elizabeth Prentice-Gaytan, D.O.

  • Internal Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1295182236
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
347277 Issued in CO
Practice address
1400 E Boulder St Ste 700
Colorado Springs, CO 80909-5533
Phone
(719) 365-7172
Fax
(719) 365-7668
NPI assigned
May 19, 2016
Last updated
Sep 26, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 347277 CO Primary

Addresses

Primary practice location

1400 E Boulder St Ste 700
Colorado Springs, CO 80909-5533

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 624-2420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221027002176 CO Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 0749657179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder St
Suite 700 Uchmg Cardio/Cardiac Surg Col
Colorado Springs, CO 80909-5533
Phone (719) 635-7172

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
347277COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Oct 31, 2022 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Oct 31, 2022 Accepting new patients

Locations

1400 E Boulder St
Ste 700
Colorado Springs, CO 80909
Phone (719) 365-7172

4110 Briargate Pkwy
Ste 400
Colorado Springs, CO 80920
Phone (719) 364-6550

1100 Carson Ave
La Junta, CO 81050
Phone (719) 383-6000

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

16222 W US Highway 24
Ste 200
Woodland Park, CO 80863
Phone (719) 686-0878

Interoperability endpoints

  • Direct secure messaging: nprenticegaytan645819@direct.hfhs.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1295182236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST STE 700",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-365-7172",
            "fax_number": "719-365-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE-GAYTAN",
        "first_name": "NICOLE",
        "middle_name": "ELIZABETH",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-19",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "347277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.