NPIMap

Organization Active NPI

Optumcare Colorado Springs, LLC

Doing business as DaVita Medical Group

  • General Practice Physician
  • Fountain, CO
National Provider Identifier
1316480783
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
OPTUMCARE COLORADO SPRINGS, LLC
Doing business as
DaVita Medical Group
Practice address
5115 Fontaine Blvd
Fountain, CO 80817-1061
Phone
(719) 392-2000
Fax
(719) 392-6937
NPI assigned
Dec 2, 2016
Last updated
Aug 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

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

Authorized official

Name
John G. Liethen
Title
Secretary
Phone
(952) 205-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

5115 Fontaine Blvd
Fountain, CO 80817-1061

Mailing address

2 S Cascade Ave
Ste 140
Colorado Springs, CO 80903-1624
Phone (719) 538-2900

Other names 1

  • DaVita Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Optumcare Colorado Medical Group LLC61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1316480783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 S CASCADE AVE",
            "address_2": "STE 140",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031624",
            "telephone_number": "719-538-2900",
            "fax_number": "719-538-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 FONTAINE BLVD",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808171061",
            "telephone_number": "719-392-2000",
            "fax_number": "719-392-6937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO SPRINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-02",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "LIETHEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-205-6262"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fountain, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.