Potomac Square Family Medicine, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

POTOMAC SQUARE FAMILY MEDICINE, LLC

Practice address

6080 W 92ND Ave Ste 1000
Westminster, CO 80031-2935

Phone

(303) 427-0796

NPI assigned

Jul 28, 2020

Last updated

Apr 15, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie Gluchacki

Title

SVP, Compliance

Phone

(508) 689-9706

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1306455092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 173848",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802173848",
            "telephone_number": "303-945-3299",
            "fax_number": "303-945-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6080 W 92ND AVE STE 1000",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "800312935",
            "telephone_number": "303-427-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC SQUARE FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-28",
        "last_updated": "2022-04-15",
        "certification_date": "2021-09-29",
        "status": "A",
        "authorized_official_last_name": "GLUCHACKI",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "SVP, COMPLIANCE",
        "authorized_official_telephone_number": "508-689-9706"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47234059",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Westminster, CO by specialty
• Primary Care Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; 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.