NPIMap

Individual provider Active NPI

Gene Edward Tullis, M.D.

  • Surgical Critical Care Physician
  • Greeley, CO
National Provider Identifier
1366422073
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
23142 Issued in CO
Practice address
1801 16TH St
Greeley, CO 80631-5154
Phone
(970) 810-2026
Fax
(970) 810-2028
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 23142 CO
Surgical Critical Care Physician 2086S0102X 23142 CO Primary

Addresses

Primary practice location

1801 16TH St
Greeley, CO 80631-5154

Mailing address

1801 16TH St
NCMC Pulm Clinic Banner Health
Greeley, CO 80631-4500
Phone (970) 810-2026

Other practice location 1

1900 Boise Ave
Loveland, CO 80538-5004
Phone (970) 810-2120

Other practice location 2

4700 Lady Moon Dr
Fort Collins, CO 80528-4426
Phone (970) 821-4500

Other practice location 3

1800 15th St
Suite 340
Greeley, CO 80631-4500
Phone (970) 378-4593

Other identifiers 2

IdentifierTypeStateIssuer
01231422MedicaidCO
P00134623OtherCORAILROAD MEDICARE

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
I20040707000219 CO Practitioner - Cardiac SurgeryPractitioner - Thoracic SurgeryPractitioner - Vascular SurgeryPractitioner - Critical Care (Intensivists) 2163409244 Reassigns benefits to 1 organization
I20230911002075 WY Practitioner - Critical Care (Intensivists)Practitioner - General SurgeryPractitioner - Thoracic Surgery 2163409244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac SurgeryAlso: Critical Care (Intensivists), Thoracic Surgery, Vascular Surgery
Education
Ohio State University College of Medicine, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Banner Health Physicians Colorado LLCGroup PAC ID 8921273038, 278 clinicians

Practice addresses (Care Compare)

1800 15TH St
Suite 340
Greeley, CO 80631-4562
Phone (970) 810-4593

Hospital & facility affiliations

  • Banner North Colorado Medical Center Hospital, Greeley, CO, CCN 060001
  • Sterling Regional Medcenter Hospital, Sterling, CO, CCN 060076
  • East Morgan County Hospital Hospital, Brush, CO, CCN 061303
  • Banner Fort Collins Medical Center Hospital, Fort Collins, CO, CCN 060126

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23142COMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Jan 1, 2012 Accepting new patients
Banner Hospital Based Physicians West LLC CurrentSince Nov 1, 2023 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Jan 1, 2012 Accepting new patients
Banner Hospital Based Physicians West LLC CurrentSince Nov 1, 2023 Accepting new patients
Banner Greeley Specialists Past Accepting new patients
Intermountain Front Range, Inc. Past Accepting new patients
Denver Cardiac Surgery PC Thoracic Surgery (Cardiothoracic Vascular Surgery) Past Accepting new patients
North Colorado Medical Center Past Accepting new patients

Locations

4700 Lady Moon Dr
Fort Collins, CO 80528
Phone (970) 521-4600

1800 15th St
Ste 340
Greeley, CO 80631
Phone (970) 351-6044

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1800 15th St
Ste 210
Greeley, CO 80631
Phone (970) 352-8216

1233 E 2nd St
Casper, WY 82601
Phone (307) 577-2171

Organizations & group practices 8

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1366422073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "address_2": "NCMC PULM CLINIC BANNER HEALTH",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806314500",
            "telephone_number": "970-810-2026",
            "fax_number": "970-810-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806315154",
            "telephone_number": "970-810-2026",
            "fax_number": "970-810-2028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Boise Ave",
            "address_purpose": "LOCATION",
            "city": "Loveland",
            "state": "CO",
            "postal_code": "805385004",
            "country_code": "US",
            "telephone_number": "970-810-2120",
            "fax_number": "970-820-2125",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4700 Lady Moon Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805284426",
            "country_code": "US",
            "telephone_number": "970-821-4500",
            "fax_number": "970-821-4501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 15th St",
            "address_2": "Suite 340",
            "address_purpose": "LOCATION",
            "city": "Greeley",
            "state": "CO",
            "postal_code": "806314500",
            "country_code": "US",
            "telephone_number": "970-378-4593",
            "fax_number": "970-378-4591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TULLIS",
        "first_name": "GENE",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CO",
            "license": "23142",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CO",
            "license": "23142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01231422",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00134623",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.