NPIMap

Organization Active NPI

Optumcare Colorado Medical Group LLC

Doing business as Optum Colorado Springs

  • General Practice Physician
  • Colorado Springs, CO
National Provider Identifier
1407252828
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP LLC
Doing business as
Optum Colorado Springs
Practice address
1633 Medical Center PT
Colorado Springs, CO 80907-5700
Phone
(719) 463-5600
NPI assigned
Nov 12, 2014
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Emily Castillo
Title
Regional Manager
Phone
(702) 480-2550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X CO Primary

Addresses

Primary practice location

1633 Medical Center PT
Colorado Springs, CO 80907-5700

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other practice location 1

2 S Cascade Ave Ste 140
Colorado Springs, CO 80903-1604
Phone (719) 538-2900

Other names 4

  • Optum Colorado Springs Doing business as
  • Colorado Springs Health Partners LLC Former legal business name
  • DaVita Medical Group Colorado Springs LLC Former legal business name
  • Optumcare Colorado Springs LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, AZ, LA, WA, IL, MI, PA, VA, AL, TN, FL, MD12 enrollments

Enrollment records 12

Enrollment IDStateProvider typePAC IDDetails
O20150129000413 CO Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 386 practitioners
16 other NPIs on this enrollment
Practice locations: Littleton, CO; Evergreen, CO; Golden, CO; Highlands Ranch, CO; Lakewood, CO; Aurora, CO; Lone Tree, CO; Longmont, CO…
O20231129002402 AZ Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ
O20231130002853 LA Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Covington, LA
O20231215002665 WA Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Seattle, WA
O20240104000568 IL Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 2 practitioners
Practice locations: Glendale Heights, IL
O20240109002941 MI Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 2 practitioners
Practice locations: Troy, MI
O20240111004990 PA Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 3 practitioners
Practice locations: Penn Valley, PA
O20240129001729 VA Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Gainesville, VA
O20240207000614 AL Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Vestavia, AL
O20240419001863 TN Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Chattanooga, TN
O20240422000726 FL Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Naples, FL
O20240802001486 MD Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 1 practitioner
Practice locations: Ellicott City, MD

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory

Locations

2405 Research Pkwy
Ste 1
Colorado Spgs, CO 80920

1633 Medical Center Pt
Fl 2
Colorado Springs, CO 80907

2405 Research Pkwy
Colorado Springs, CO 80920
Phone (719) 268-2800

2610 Tenderfoot Hill St
Ste 103
Colorado Springs, CO 80906

Practitioners & affiliated clinicians

Practitioners 419

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 419

NPI Registry JSON

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

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1407252828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 MEDICAL CENTER PT",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809075700",
            "telephone_number": "719-463-5600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 S Cascade Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809031604",
            "country_code": "US",
            "telephone_number": "719-538-2900",
            "fax_number": "719-538-2990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "702-480-2550"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum Colorado Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Springs Health Partners LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "DaVita Medical Group Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Optumcare Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; 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.