NPIMap

Organization Active NPI

St Lukes Medical Clinic LLC

  • Internal Medicine Physician
  • Fort Collins, CO
National Provider Identifier
1407953581
Registry record updated Mar 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
24854 Issued in CO
Legal business name
ST LUKES MEDICAL CLINIC LLC
Practice address
1101 Oakridge Dr
Suite B
Fort Collins, CO 80525-5591
Phone
(970) 223-1199
Fax
(970) 223-9566
NPI assigned
Sep 20, 2006
Last updated
Mar 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2008

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

Authorized official

Name
Michael J Lynch, M.D.
Title
Owner
Phone
(970) 223-1199

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 57743 CO
Internal Medicine Physician 207R00000X 24854 CO Primary

Addresses

Primary practice location

1101 Oakridge Dr
Suite B
Fort Collins, CO 80525-5591

Mailing address

1101 Oakridge Dr
Suite B
Fort Collins, CO 80525-5591
Phone (970) 223-1199

Other identifiers 1

IdentifierTypeStateIssuer
07009216MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061128000029 CO Part B Supplier - Clinic/Group Practice 5698773737 Receives reassigned benefits from 10 practitioners
Practice locations: Fort Collins, CO

National Provider Directory

National Provider Directory

Locations

1101 Oakridge Dr
Unit B
Fort Collins, CO 80525
Phone (970) 223-1199

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18545/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1407953581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 OAKRIDGE DR",
            "address_2": "SUITE B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255591",
            "telephone_number": "970-223-1199",
            "fax_number": "970-223-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 OAKRIDGE DR",
            "address_2": "SUITE B",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255591",
            "telephone_number": "970-223-1199",
            "fax_number": "970-223-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-03-24",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-223-1199",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "57743",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "24854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07009216",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; 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.