Individual provider Active NPI

Roya Brooke Mirhossaini

  • Dermatology Physician
  • Colorado Springs, CO
National Provider Identifier
1356979181
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
DR.0073701 Issued in CO
Practice address
2060 Briargate Pkwy Ste 150
Colorado Springs, CO 80920-7660
Phone
(719) 471-1763
Fax
(719) 471-2498
NPI assigned
Mar 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Dermatology Physician 207N00000X DR.0073701 CO Primary

Addresses

Primary practice location

2060 Briargate Pkwy Ste 150
Colorado Springs, CO 80920-7660

Mailing address

2060 Briargate Pkwy Ste 150
Colorado Springs, CO 80920-7660
Phone (719) 471-1763

Other practice location 1

4445 Magnolia Ave
Riverside, CA 92501-4199
Phone (951) 788-3536

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240801001024 CO Practitioner - Dermatology 6608265061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Colorado School of Medicine, Aurora, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Colorado Springs Dermatology Clinic, P.C.Group PAC ID 2264424738, 11 clinicians

Practice addresses (Care Compare)

2060 Briargate Pkwy
Suite 150
Colorado Springs, CO 80920-7660
Phone 7194711763204

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision27
Removal of skin lesions676
Removal or shaving of skin growth53
Skin biopsy357

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Springs Dermatology Clinic, P.C. Dermatology CurrentSince Sep 9, 2024 Accepting new patients
Colorado Springs Dermatology Clinic, P.C. Dermatology CurrentSince Sep 9, 2024 Accepting new patients
Colorado Springs Dermatology Clinic, P.C. Dermatology CurrentSince Sep 9, 2024 Accepting new patients

Locations

1332 Bauer Ln
Canon City, CO 81212
Phone (719) 275-7485

2060 Briargate Pkwy
Ste 150
Colorado Springs, CO 80920
Phone (719) 471-1763

170 S Parkside Dr
Colorado Springs, CO 80910
Phone (719) 471-1763

406 N Main St
Pueblo, CO 81003
Phone (719) 566-0176

Interoperability endpoints

  • Direct secure messaging: rmirhossaini@csderm.emadirect.md

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.

NPI Registry JSON

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

{
    "created_epoch": "1585353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1356979181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 BRIARGATE PKWY STE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207660",
            "telephone_number": "719-471-1763",
            "fax_number": "719-471-2498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 BRIARGATE PKWY STE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207660",
            "telephone_number": "719-471-1763",
            "fax_number": "719-471-2498"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4445 Magnolia Ave",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925014199",
            "country_code": "US",
            "telephone_number": "951-788-3536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRHOSSAINI",
        "first_name": "ROYA",
        "middle_name": "BROOKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-28",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "DR.0073701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.