NPIMap

Individual provider Active NPI

Kristin Wallick, M.D.

  • Pulmonary Disease Physician
  • Fort Collins, CO
National Provider Identifier
1356311203
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
DR.0037197 Issued in CO
Practice address
2121 E Harmony Rd
Ste 300
Fort Collins, CO 80528-3400
Phone
(970) 224-9102
Fax
(970) 224-9112
NPI assigned
Jan 24, 2006
Last updated
Aug 16, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DR.0037197 CO
Critical Care Medicine (Internal Medicine) Physician 207RC0200X DR.0037197 CO
Pulmonary Disease Physician 207RP1001X DR.0037197 CO Primary

Addresses

Primary practice location

2121 E Harmony Rd
Ste 300
Fort Collins, CO 80528-3400

Mailing address

2121 E Harmony Rd
Suite 300
Fort Collins, CO 80528-3400
Phone (970) 224-9102

Other identifiers 3

IdentifierTypeStateIssuer
36659231MedicaidCO
P00031437OtherCORAILROAD MEDICARE
119016400MedicaidWY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, WY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20071010000145 CO Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 6406862606 Reassigns benefits to 1 organization
I20150314000376 WY Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 6406862606 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Internal Medicine
Education
Medical College of Wisconsin, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, shared by 2 NPIs, 2,425 clinicians

Practice addresses (Care Compare)

1024 S Lemay Ave
Fort Collins, CO 80524-3929

2500 Rocky Mountain Ave
Loveland, CO 80538-9004

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone (307) 634-1311

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0037197COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Pulmonary Disease Current Accepting new patients
Poudre Valley Medical Group, LLC Pulmonary Disease CurrentSince Dec 17, 2012 Accepting new patients
Critical Care & Pulmonary Consultants, PC Critical Care Medicine PastSince Jul 1, 2002 Accepting new patients
Philippe G Lopez MD PC Critical Care Medicine PastSince Jun 16, 2024 Accepting new patients
Northern Colorado Pulmonary Consutlants, PC Critical Care Medicine Past Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

2121 E Harmony Rd
Unit 300
Fort Collins, CO 80528
Phone (970) 224-0429

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

5050 Powderhouse Rd
Cheyenne, WY 82009
Phone (307) 634-1311

3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1356311203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "SUITE 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-224-9102",
            "fax_number": "970-224-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E HARMONY RD",
            "address_2": "STE 300",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805283400",
            "telephone_number": "970-224-9102",
            "fax_number": "970-224-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLICK",
        "first_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0037197",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CO",
            "license": "DR.0037197",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CO",
            "license": "DR.0037197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36659231",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00031437",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119016400",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.