NPIMap

Organization Active NPI

Colorado Coalition for the Homeless

Doing business as Stout Street Clinic

  • Federally Qualified Health Center (FQHC)
  • Denver, CO
National Provider Identifier
1396793030
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLORADO COALITION FOR THE HOMELESS
Doing business as
Stout Street Clinic
Practice address
2130 Stout St
Denver, CO 80205-2827
Phone
(303) 293-2220
Fax
(303) 293-6966
NPI assigned
May 5, 2006
Last updated
Jan 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2025

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

Authorized official

Name
Pete J Stoller
Title
Cfo
Phone
(303) 312-9606

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1042 CO
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

2130 Stout St
Denver, CO 80205-2827

Mailing address

2111 Champa St
Denver, CO 80205-2529
Phone (303) 293-2217

Other identifiers 1

IdentifierTypeStateIssuer
05638390MedicaidCO

Other names 1

  • Stout Street Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040526000359 CO Part B Supplier - Clinic/Group Practice 7618958687 Receives reassigned benefits from 22 practitioners
Practice locations: Denver, CO
O20110307000293 CO Part A Provider - Federally Qualified Health Center (FQHC) 7618958687 Practice locations: Denver, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396793030. Details of each certification follow.

Federally qualified health center certification: CCN 061835

Legal name
COLORADO COALITION FOR THE HOMELESS
Doing business as
STOUT STREET CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 1, 1984 in CO
Enrollment address
2130 Stout St
Denver, CO 80205-2827

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory

Locations

2100 Stout St
Denver, CO 80205
Phone (303) 296-4996

2130 Stout St
Denver, CO 80205
Phone (303) 293-2217

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Charles F Savage Individual Corporate DirectorBoard Member Nov 10, 2015
Leanne D Wheeler Individual Corporate DirectorBoard Member Jan 10, 2013
Cuicatl G Montoya Individual Corporate Director Mar 1, 2020
James R Davis Individual Corporate DirectorBoard Member Jan 4, 2011
Jynx N Messacar Individual Corporate DirectorBoard Member Jul 1, 2014
James R Brown Individual Corporate DirectorBoard Member Mar 2, 2004
Randle Loeb Individual Corporate DirectorBoard Member Jul 10, 2007
Jane Tidball Individual Corporate Director Mar 1, 2020
Christopher Aaron Bates Individual Corporate DirectorBoard Member Sep 3, 2013
Jennifer a Bettridge Individual Corporate DirectorBoard Member Oct 6, 2015
Sam Mamet Individual Corporate Director Mar 1, 2020
Norman Haglund Individual Corporate DirectorBoard Member Aug 2, 2016
Donna R Hilton Individual Corporate Director Mar 1, 2020
Andrew Romero Individual Corporate Director Mar 1, 2020
Britta Elise Monson Fisher Individual Operational/Managerial ControlCeo Apr 5, 2023 100%
James Winston Individual Corporate DirectorBoard Member May 7, 1997
Thomas R Reid Individual Corporate DirectorBoard Member Mar 6, 2007
Katherine H Kaley Individual Corporate DirectorBoard Member Jan 5, 2017
Theresa Helweg Individual W-2 Managing EmployeeDirector of Revenue Cycle Jan 1, 2013
Pete Stoller Individual Corporate OfficerCfo Jan 1, 2014
W-2 Managing EmployeeCfo Jan 1, 2014 100%
Lori a Malone Individual Corporate DirectorBoard Member Feb 8, 2017
Darrell a Brown Individual Corporate DirectorBoard Member Sep 10, 2013
Joel S Neckers Individual Corporate DirectorBoard Member Jan 5, 2017
Melissa Jones Individual Corporate Director Mar 1, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West End Health CenterDenver, CO, CCN 061922 Federally qualified health center 5% Or Greater Direct Ownership Interest Apr 10, 2012
Ft Lyon Health Care for the HomelessFort Lyon, CO, CCN 061952 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 2, 2014
2100 Broadway Services BuildingDenver, CO, CCN 061955 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 20, 2014
Colorado Coalition for the HomelessDenver, CO, CCN 061035 Federally qualified health center 5% Or Greater Direct Ownership Interest (0.05%) Mar 7, 2022
Stout Street Recuperative Care CenterDenver, CO, CCN 061045 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2022

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735776000000",
    "number": "1396793030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 CHAMPA ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052529",
            "telephone_number": "303-293-2217",
            "fax_number": "303-293-2309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 STOUT ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052827",
            "telephone_number": "303-293-2220",
            "fax_number": "303-293-6966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO COALITION FOR THE HOMELESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A",
        "authorized_official_last_name": "STOLLER",
        "authorized_official_first_name": "PETE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-312-9606"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CO",
            "license": "1042",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638390",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stout Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stout Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.