NPIMap

Organization Active NPI

Boulder Medical Center, P.C.

  • Multi-Specialty Clinic/Center
  • Boulder, CO
National Provider Identifier
1306820923
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
BOULDER MEDICAL CENTER, P.C.
Practice address
2750 Broadway St
Boulder, CO 80304-3573
Phone
(303) 440-3000
NPI assigned
Dec 6, 2005
Last updated
Oct 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Casandra Richards
Title
Credentialing Coordinator
Phone
(303) 440-3076

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

2750 Broadway St
Boulder, CO 80304-3573

Mailing address

2750 Broadway St
Boulder, CO 80304-3573
Phone (303) 440-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031105000512 CO Part B Supplier - Clinic/Group Practice 4183536204 Receives reassigned benefits from 99 practitioners
5 other NPIs on this enrollment
Practice locations: Erie, CO; Louisville, CO; Boulder, CO; Longmont, CO
O20040203000968 CO Part B Supplier - Independent Clinical Laboratory 4183536204 Practice locations: Boulder, CO
O20100930064696 CO DME Supplier - Multi-Specialty - Physician 4183536204 Practice locations: Boulder, CO

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1551 Professional Ln
Unit 240
Longmont, CO 80501
Phone (303) 938-4710

Practitioners & affiliated clinicians

Practitioners 99

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 99

NPI Registry JSON

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1306820923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043573",
            "telephone_number": "303-440-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043573",
            "telephone_number": "303-440-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER MEDICAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-06",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "CASANDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "303-440-3076"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 20, 2023; 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.