NPIMap

Organization Active NPI

Western Nephrology & Metabolic Bone Disease, P.C.

  • Nephrology Physician
  • Longmont, CO
National Provider Identifier
1336754860
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
WESTERN NEPHROLOGY & METABOLIC BONE DISEASE, P.C.
Practice address
1960 Ken Pratt Blvd Ste B
Longmont, CO 80501-6092
Phone
(303) 776-7759
Fax
(303) 456-7490
NPI assigned
Sep 11, 2020
Last updated
Sep 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Authorized official

Name
Carrie Mooney
Title
Credentialing Coordinator
Phone
(303) 456-5495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

1960 Ken Pratt Blvd Ste B
Longmont, CO 80501-6092

Mailing address

4891 Independence St Ste 120
Wheat Ridge, CO 80033-6713
Phone (303) 456-5495

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0949132Western Nephrology & Metabolic Bone Disease, PC1960 Ken Pratt Blvd, Suite B, Longmont, CO 80501Provider-performed microscopyNov 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Sujatha Venkatesh MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1960 Ken Pratt Blvd
Ste B
Longmont, CO 80501
Phone (303) 443-4200

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1336754860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4891 INDEPENDENCE ST STE 120",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336713",
            "telephone_number": "303-456-5495",
            "fax_number": "303-456-7490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 KEN PRATT BLVD STE B",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016092",
            "telephone_number": "303-776-7759",
            "fax_number": "303-456-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN NEPHROLOGY & METABOLIC BONE DISEASE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "MOONEY",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "303-456-5495"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.