NPIMap

Individual provider Active NPI

Tammie N. Brueckner, PA-C

  • Physician Assistant
  • Lakewood, CO
National Provider Identifier
1407212376
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0009307 Issued in CO
Practice address
1746 Cole Blvd Ste 100
Lakewood, CO 80401-3208
Phone
(303) 914-8800
NPI assigned
Jan 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA57558 CA
Physician Assistant 363A00000X PA.0009307 CO Primary

Addresses

Primary practice location

1746 Cole Blvd Ste 100
Lakewood, CO 80401-3208

Mailing address

1746 Cole Blvd Ste 100
Lakewood, CO 80401-3208

Other practice location 1

200 W Arbor Dr Bldg 300
San Diego, CA 92103-1911
Phone (800) 926-8273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200228002336 CA Practitioner - Physician Assistant 9739483256 Reassigns benefits to 1 organization
I20250909004652 CO Practitioner - Physician Assistant 9739483256 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diversified Radiology of Colorado IncGroup PAC ID 0143132316, 92 clinicians

Practice addresses (Care Compare)

1600 Prairie Ctr Pkwy
Brighton, CO 80601-4006
Phone (303) 914-8800

4567 E 9TH Ave
Denver, CO 80220-3908
Phone (303) 914-8800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3249NEMDProfessional Counselor
PA57558CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Jan 14, 2020 Accepting new patients
Spectrum Medical Imaging, LLC CurrentSince Oct 4, 2025 Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients
Georgia Radiology Imaging Consultants, LLC Past Accepting new patients
Mori Bean and Brooks Inc Physician Assistant Past Accepting new patients
Radiology Associates of Macon PC PastSince Oct 4, 2025 Accepting new patients

Locations

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

9350 Campus Point Dr
La Jolla, CA 92037
Phone (858) 657-0583

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

200 W Arbor Dr
Bldg 300
San Diego, CA 92103

8929 University Center Ln
Ste 101
San Diego, CA 92122
Phone (858) 457-4227

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1407212376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1746 COLE BLVD STE 100",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "804013208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1746 COLE BLVD STE 100",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "804013208",
            "telephone_number": "303-914-8800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Arbor Dr Bldg 300",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921031911",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUECKNER",
        "first_name": "TAMMIE",
        "middle_name": "N.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-08",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA57558",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0009307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CO

Sources for this page

Verify at the official NPI Registry.