Active NPI
Alex Raimes Cudkowicz, MD
- Anatomic Pathology & Clinical Pathology Physician
- Cortez, CO
National Provider Identifier
1356539084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 34477
- Practice address
- 1011 N Mildred Rd
Cortez, CO 81321-2435 - Phone
- (970) 565-8482
- Fax
- (970) 565-8478
- NPI assigned
- Oct 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 34477 | CO | Primary |
Addresses
Primary practice location
1011 N Mildred Rd
Cortez, CO 81321-2435
Mailing address
1011 N Mildred Rd
Cortez, CO 81321-2435
Phone (970) 565-8482
Other practice location 1
1311 N Mildred Rd
Laboratory
Cortez, CO 81321-2231
Phone (970) 564-2083
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01344779 | Medicaid | CO | |
| Q4652 | Other | NM | NEW MEXICO MEDICAID |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 34477 | CO | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cedar Diagnostics, LLC | Past | Accepting new patients |
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.
-
- Clinical Medical Laboratory
- Pagosa Springs, CO
- NPI 1235768334
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545264000000",
"number": "1356539084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1011 N MILDRED RD",
"city": "CORTEZ",
"state": "CO",
"postal_code": "813212435",
"telephone_number": "970-565-8482",
"fax_number": "970-565-8478"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1011 N MILDRED RD",
"city": "CORTEZ",
"state": "CO",
"postal_code": "813212435",
"telephone_number": "970-565-8482",
"fax_number": "970-565-8478"
}
],
"practiceLocations": [
{
"address_1": "1311 N Mildred Rd",
"address_2": "Laboratory",
"address_purpose": "LOCATION",
"city": "Cortez",
"state": "CO",
"postal_code": "813212231",
"country_code": "US",
"telephone_number": "970-564-2083",
"fax_number": "970-564-2091",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CUDKOWICZ",
"first_name": "ALEX",
"middle_name": "RAIMES",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-09",
"last_updated": "2018-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "CO",
"license": "34477",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01344779",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW MEXICO MEDICAID",
"identifier": "Q4652",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cortez, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.