John D. Breck, D.O.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

0055792 Issued in CO

Practice address

1900 Wardenburg Way
Boulder, CO 80309

Phone

(303) 492-5101

NPI assigned

Jun 27, 2011

Last updated

Jul 18, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1407142623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WARDENBURG WAY",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803090001",
            "telephone_number": "303-492-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WARDENBURG WAY",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80309",
            "telephone_number": "303-492-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRECK",
        "first_name": "JOHN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-27",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CO",
            "license": "0055792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren C Brave, MD
• Deborah Ann Breakell
• Breakthrough Regenerative Orthopedics
• Cheryl Ann Breault, MA, LPC, CACIII
• Amy Breaux
• Allison C Breed, MSW
• Gertie Breffle, MA, LPC
• Kidd J Brehm
• Alison Bremner, D.C
• Lee K Brennan, PT

• Sports Medicine (Family Medicine) Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Sports Medicine (Family Medicine) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.