NPIMap

Organization Active NPI

Colorado Springs Endocrine Clinic PC

  • Endocrinology, Diabetes & Metabolism Physician
  • Colorado Springs, CO
National Provider Identifier
1336101765
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
COLORADO SPRINGS ENDOCRINE CLINIC PC
Practice address
325 E Fontanero St
Colorado Springs Endocrine Clinic PC
Colorado Springs, CO 80907-7533
Phone
(719) 636-3829
Fax
(719) 633-8571
NPI assigned
Apr 3, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Susan E Henley, MDNPI 1083683049
Title
Corporate President
Phone
(719) 636-3829

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040414001255 CO Part B Supplier - Clinic/Group Practice 9032103676 Receives reassigned benefits from 3 practitioners
Practice locations: Colorado Springs, CO

National Provider Directory

Locations

325 E Fontanero St
#101
Colorado Springs, CO 80907
Phone (303) 636-3829

325 E Fontanero St
Ste 101
Colorado Springs, CO 80907
Phone (719) 636-3829

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X Primary

Addresses

NPPES NPI Registry

Primary practice location

325 E Fontanero St
Colorado Springs Endocrine Clinic PC
Colorado Springs, CO 80907-7533

Mailing address

325 E Fontanero St
Colorado Springs Endocrine Clinic PC
Colorado Springs, CO 80907-7533
Phone (719) 636-3829

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
04008066MedicaidCO

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336101765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E FONTANERO ST",
            "address_2": "COLORADO SPRINGS ENDOCRINE CLINIC PC",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809077533",
            "telephone_number": "719-636-3829",
            "fax_number": "719-633-8571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E FONTANERO ST",
            "address_2": "COLORADO SPRINGS ENDOCRINE CLINIC PC",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809077533",
            "telephone_number": "719-636-3829",
            "fax_number": "719-633-8571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO SPRINGS ENDOCRINE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENLEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CORPORATE PRESIDENT",
        "authorized_official_telephone_number": "719-636-3829",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04008066",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.