Active NPI
William Jia Gottlieb, MD
- Family Medicine Physician
- Boulder, CO
National Provider Identifier
1396990719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 26361
- Practice address
- 331 Maxwell Ave
Boulder, CO 80304-3972 - Phone
- (303) 444-2425
- Fax
- (303) 444-7995
- NPI assigned
- Nov 26, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 26361 | CO | Primary |
Addresses
Primary practice location
331 Maxwell Ave
Boulder, CO 80304-3972
Mailing address
331 Maxwell Ave
Boulder, CO 80304-3972
Phone (303) 444-2425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 15, 2018 through Mar 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26361 | CO | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227657600000",
"number": "1396990719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "331 MAXWELL AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043972",
"telephone_number": "303-444-2425",
"fax_number": "303-444-7995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "331 MAXWELL AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803043972",
"telephone_number": "303-444-2425",
"fax_number": "303-444-7995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTLIEB",
"first_name": "WILLIAM",
"middle_name": "JIA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-26",
"last_updated": "2008-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "26361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.