NPIMap

Organization Active NPI

Steadman Clinic Professional LLC

  • Specialist
  • Edwards, CO
National Provider Identifier
1376086769
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
STEADMAN CLINIC PROFESSIONAL LLC
Practice address
322 Beard Creek Rd
Edwards, CO 81632-6426
Phone
(970) 476-1100
Fax
(970) 569-3351
NPI assigned
Dec 2, 2016
Last updated
Dec 2, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

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

Authorized official

Name
Greg Paschke
Title
Ceo
Phone
(970) 476-1100

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X CO Primary
Orthopaedic Surgery Physician 207X00000X NU
Orthopaedic Hand Surgery Physician 207XS0106X NU
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X NU
Orthopaedic Surgery of the Spine Physician 207XS0117X NU
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X NU
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU
Orthopaedic Trauma Physician 207XX0801X NU

Addresses

Primary practice location

322 Beard Creek Rd
Edwards, CO 81632-6426

Mailing address

181 W Meadow Dr
Ste 400
Vail, CO 81657-5242
Phone (970) 476-1100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170120000076 CO DME Supplier - Physician - General PracticeDME Supplier - Physician - Orthopedic/Orthopedic Surgery 7719876226 Practice locations: Edwards, CO

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Steadman Clinic Prof LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1376086769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 W MEADOW DR",
            "address_2": "STE 400",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816575242",
            "telephone_number": "970-476-1100",
            "fax_number": "970-479-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 BEARD CREEK RD",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816326426",
            "telephone_number": "970-476-1100",
            "fax_number": "970-569-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEADMAN CLINIC PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-02",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "PASCHKE",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-476-1100"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edwards, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.