NPIMap

Organization Active NPI

Northeast Colorado Family Medicine Associates, P.C.

  • Family Medicine Physician
  • Sterling, CO
National Provider Identifier
1386846947
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02-20011 Issued in CO
Legal business name
NORTHEAST COLORADO FAMILY MEDICINE ASSOCIATES, P.C.
Practice address
1405 S 8TH Ave
Suite 103
Sterling, CO 80751-4563
Phone
(970) 522-3304
Fax
(970) 522-4615
NPI assigned
Jun 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Authorized official

Name
Dr. Curtis C Clark, M.D.NPI 1134169360
Title
President
Phone
(970) 522-3304

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 02-20011 CO Primary

Addresses

Primary practice location

1405 S 8TH Ave
Suite 103
Sterling, CO 80751-4563

Mailing address

1405 S 8TH Ave
Suite 103
Sterling, CO 80751-4563
Phone (970) 522-3304

Other identifiers 2

IdentifierTypeStateIssuer
04113049MedicaidCO
11304OtherBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331000532 CO Part B Supplier - Clinic/Group Practice 2062404031 Receives reassigned benefits from 8 practitioners
Practice locations: Sterling, CO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206921600000",
    "number": "1386846947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 S 8TH AVE",
            "address_2": "SUITE 103",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807514563",
            "telephone_number": "970-522-3304",
            "fax_number": "970-522-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 S 8TH AVE",
            "address_2": "SUITE 103",
            "city": "STERLING",
            "state": "CO",
            "postal_code": "807514563",
            "telephone_number": "970-522-3304",
            "fax_number": "970-522-4615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST COLORADO FAMILY MEDICINE ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2008-03-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CURTIS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "970-522-3304",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "02-20011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04113049",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "11304",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; 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.