NPIMap

Individual provider Active NPI

Theodore R Villavicencio, MD

  • Family Medicine Physician
  • Conifer, CO
National Provider Identifier
1366496366
Registry record updated Nov 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
31320 Issued in CO
Practice address
10791 Kitty Dr
Suite a
Conifer, CO 80433
Phone
(303) 838-4686
Fax
(303) 816-4905
NPI assigned
May 22, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 25

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.

View all 25

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Colorado School of Medicine, Denver, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care PA 545 clinicians

Practice addresses (Care Compare)

11185 W 6TH Ave
Lakewood, CO 80215-5538
Phone (972) 720-7768

1730 Blake St
Suite 100
Denver, CO 80202-1274
Phone (303) 296-2273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060221000446 CO Practitioner - Family Practice 5496646259 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31320COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care PA CurrentSince Oct 5, 2011 Accepting new patients
American Current Care P.a. CurrentSince Oct 5, 2011 Accepting new patients

Locations

1730 Blake St
Ste 100
Denver, CO 80202
Phone (303) 296-2273

5080 Spectrum Dr
Ste 1200W
Addison, TX 75001

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31320 CO Primary

Addresses

NPPES NPI Registry

Primary practice location

10791 Kitty Dr
Suite a
Conifer, CO 80433

Mailing address

10791 Kitty Dr
Suite a
Conifer, CO 80433
Phone (303) 838-4686

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 9, 2011.

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320796800000",
    "number": "1366496366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10791 KITTY DR",
            "address_2": "SUITE A",
            "city": "CONIFER",
            "state": "CO",
            "postal_code": "80433",
            "telephone_number": "303-838-4686",
            "fax_number": "303-816-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10791 KITTY DR",
            "address_2": "SUITE A",
            "city": "CONIFER",
            "state": "CO",
            "postal_code": "80433",
            "telephone_number": "303-838-4686",
            "fax_number": "303-816-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLAVICENCIO",
        "first_name": "THEODORE",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2011-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "31320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conifer, CO

Sources for this page

Verify at the official NPI Registry.