NPIMap

Organization Active NPI

Magnolia Medical

  • Psychologist
  • Denver, CO
National Provider Identifier
1346609302
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MAGNOLIA MEDICAL
Practice address
2172 S Clermont St
Denver, CO 80222-5007
Phone
(303) 209-5115
NPI assigned
Feb 18, 2016
Last updated
Nov 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Authorized official

Name
Pradeep Raj RaiNPI 1184863631
Title
Medical Director
Phone
(303) 209-5115

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

2172 S Clermont St
Denver, CO 80222-5007

Mailing address

2172 S Clermont St
Denver, CO 80222-5007

National Provider Directory

National Provider Directory

Locations

10515 E 40th Ave
Denver, CO 80239

10160 W 50th Ave
Wheat Ridge, CO 80033

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478736000000",
    "number": "1346609302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2172 S CLERMONT ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802225007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2172 S CLERMONT ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802225007",
            "telephone_number": "303-209-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-18",
        "last_updated": "2016-11-10",
        "status": "A",
        "authorized_official_last_name": "RAI",
        "authorized_official_first_name": "PRADEEP",
        "authorized_official_middle_name": "RAJ",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "303-209-5115"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; 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.