NPIMap

Individual provider Active NPI

Bradley Grant Changstrom, M.D.

  • Sports Medicine (Internal Medicine) Physician
  • Boulder, CO
National Provider Identifier
1306136288
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X
License
55360 Issued in CO
Practice address
2150 Stadium Dr
Boulder, CO 80309-7255
Phone
(720) 848-2300
NPI assigned
Apr 13, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR.0055360 CO
Sports Medicine (Internal Medicine) Physician 207RS0010X 55360 CO Primary

Addresses

Primary practice location

2150 Stadium Dr
Boulder, CO 80309-7255

Mailing address

PO Box 110429
Aurora, CO 80042
Phone (303) 493-7000

Other practice location 1

8111 E Lowry Blvd
Denver, CO 80230-7255
Phone (720) 848-9500

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
I20151103001979 CO Practitioner - Sports MedicinePractitioner - Family PracticePractitioner - Internal Medicine 0244465482 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice, Internal Medicine
Education
University of Colorado School of Medicine, Aurora, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physicians IncorporatedGroup PAC ID 3476465667, 3,189 clinicians

Practice addresses (Care Compare)

2150 Stadium Dr 2ND Floor
Cu Boulder Sports Medicine
Boulder, CO 80309-3979
Phone (303) 441-2219

Hospital & facility affiliations

  • University of Colorado Hospital Authority Hospital, Aurora, CO, CCN 060024
  • Boulder Community Health Hospital, Boulder, CO, CCN 060027

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55360COMDSports Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians Incorporated Internal Medicine Current Accepting new patients
University Physicians, Incorporated Sports Medicine CurrentSince Aug 15, 2015 Accepting new patients
University Physicians Incorporated CurrentSince Aug 15, 2015 Accepting new patients
University Physicians, Incorporated Past Accepting new patients

Locations

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

1635 Aurora Ct
#B178
Aurora, CO 80045

2150 Stadium Dr 2nd
Boulder, CO 80309
Phone (303) 315-9900

2150 Stadium Dr
Boulder, CO 80309
Phone (303) 315-9900

8111 E Lowry Blvd
Ste 120
Denver, CO 80230
Phone (720) 810-5442

Dept 1061
Denver, CO 80256

8111 E Lowry Blvd
Denver, CO 80230
Phone (720) 848-9500

3055 Roslyn St
Unit 200
Denver, CO 80238
Phone (303) 350-7632

Organizations & group practices 4

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

Hospital & facility affiliations 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1306136288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "80042",
            "telephone_number": "303-493-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 STADIUM DR",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803097255",
            "telephone_number": "720-848-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8111 E Lowry Blvd",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802307255",
            "country_code": "US",
            "telephone_number": "720-848-9500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANGSTROM",
        "first_name": "BRADLEY",
        "middle_name": "GRANT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-13",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0055360",
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "CO",
            "license": "55360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.