Individual provider Active NPI

Richard James Pass, D.D.S.

  • Dentist
  • Fort Collins, CO
National Provider Identifier
1316141583
Registry record updated Jun 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10038 Issued in CO
Practice address
605 S. College Avenue #100
Fort Collins, CO 80524
Phone
(970) 482-6841
Fax
(970) 484-5555
NPI assigned
Jun 12, 2007
Last updated
Jun 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10038 CO Primary
General Practice Dentistry 1223G0001X 60479 KS

Addresses

Primary practice location

605 S. College Avenue #100
Fort Collins, CO 80524

Mailing address

605 S. College Avenue #100
Fort Collins, CO 80524
Phone (970) 482-6841

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160330000933 CO Order and Referring Only - DentistPractitioner - Dentist 1759688138

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10038COMDDentist
60479KSMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Foothills Family Dental, P.C. General Practice CurrentSince Dec 3, 2009 Accepting new patients

Locations

523 Remington St
Fort Collins, CO 80524
Phone (720) 491-1998

605 S College Ave
#100
Fort Collins, CO 80524
Phone (970) 482-6841

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655424000000",
    "number": "1316141583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S. COLLEGE AVENUE #100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80524",
            "telephone_number": "970-482-6841",
            "fax_number": "970-484-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S. COLLEGE AVENUE #100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80524",
            "telephone_number": "970-482-6841",
            "fax_number": "970-484-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASS",
        "first_name": "RICHARD",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "10038",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60479",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.