NPIMap

Organization Active NPI

Optumcare Colorado Medical Group LLC

Doing business as Optum Colorado Springs - Monument

  • General Practice Physician
  • Monument, CO
National Provider Identifier
1346632684
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP LLC
Doing business as
Optum Colorado Springs - Monument
Practice address
15909 Jackson Creek Pkwy
Monument, CO 80132-8693
Phone
(719) 488-9933
Fax
(719) 488-7396
NPI assigned
Feb 24, 2015
Last updated
Aug 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Emily Castillo
Title
Associate Director Credentialing
Phone
(702) 579-3253

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU
General Practice Physician 208D00000X NU Primary
Non-Pharmacy Dispensing Site 332900000X NU

Addresses

Primary practice location

15909 Jackson Creek Pkwy
Monument, CO 80132-8693

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other names 4

  • Optum Colorado Springs - Monument Doing business as
  • Colorado Springs Health Partners LLC Former legal business name
  • DaVita Medical Group Colorado Springs LLC Former legal business name
  • OptumCare Colorado Springs LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Davita Med GRP Co Springs61 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": "1424736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1346632684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15909 JACKSON CREEK PKWY",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801328693",
            "telephone_number": "719-488-9933",
            "fax_number": "719-488-7396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-24",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "702-579-3253"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum Colorado Springs - Monument",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Springs Health Partners LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "DaVita Medical Group Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "OptumCare Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Monument, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.