Individual provider Active NPI

Michael J. Nerenberg, M.D.

  • Emergency Medicine Physician
  • Pueblo, CO
National Provider Identifier
1336122167
Registry record updated Mar 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
28755 Issued in CO
Practice address
400 W 16TH St
Pueblo, CO 81003-2745
Phone
(719) 584-4306
Fax
(719) 595-7886
NPI assigned
Nov 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 28755 CO Primary

Addresses

Primary practice location

400 W 16TH St
Pueblo, CO 81003-2745

Mailing address

400 W 16TH St
Pueblo, CO 81003-2745
Phone (719) 584-4306

Other identifiers 1

IdentifierTypeStateIssuer
01287556MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28755COMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pueblo Pathology Group, PC Current Accepting new patients

Locations

400 W 16th St
Pueblo, CO 81003
Phone (719) 584-4000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236038400000",
    "number": "1336122167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W 16TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032745",
            "telephone_number": "719-584-4306",
            "fax_number": "719-595-7886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NERENBERG",
        "first_name": "MICHAEL",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2009-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "28755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01287556",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2009; 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.