Individual provider Active NPI

Joshua Lake

  • Certified Registered Nurse Anesthetist
  • Delta, CO
National Provider Identifier
1356863625
Registry record updated Jun 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0996084 Issued in CO
Practice address
1501 E 3Rd St
Delta, CO 81416-2815
Phone
(970) 874-7681
NPI assigned
Jul 8, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 0996084 CO Primary
Certified Registered Nurse Anesthetist 367500000X NA IN

Addresses

Primary practice location

1501 E 3Rd St
Delta, CO 81416-2815

Mailing address

PO Box 10100
Delta, CO 81416-0008
Phone (970) 874-2470

Other identifiers 1

IdentifierTypeStateIssuer
9000190203MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201223000562 CO Practitioner - Certified Registered Nurse Anesthetist (Crna) 6305118621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delta County Memorial HospitalGroup PAC ID 1850200601, 107 clinicians

Practice addresses (Care Compare)

1501 E 3Rd St
Oncology and Hematology
Delta, CO 81416-2815
Phone (970) 399-2895

Hospital & facility affiliations

  • Delta County Memorial Hospital Hospital, Delta, CO, CCN 060071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
0996084COMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Delta County Memorial Hospital CurrentSince Jan 1, 2021 Accepting new patients
Delta County Memorial Hospital CurrentSince Jan 1, 2021 Accepting new patients
Delta County Memorial Hospital Current Accepting new patients

Locations

236 Cottonwood St
Delta, CO 81416
Phone (970) 874-7681

1501 E 3rd St
Delta, CO 81416
Phone (970) 874-2470

1450 Burgess St
Delta, CO 81416
Phone (970) 874-7668

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1499472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1356863625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10100",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814160008",
            "telephone_number": "970-874-2470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 E 3RD ST",
            "city": "DELTA",
            "state": "CO",
            "postal_code": "814162815",
            "telephone_number": "970-874-7681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "JOSHUA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-08",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": "0996084",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "NA",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000190203",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Delta, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.