Active NPI
Gregory Lee Mesa, M.D.
- Family Medicine Physician
- Golden, CO
National Provider Identifier
1417099490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 48078
- Practice address
- 5920 McIntyre St
Golden, CO 80403-7445 - Phone
- (303) 949-1250
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | BP10025451 | TX | |
| Family Medicine Physician | 207Q00000X | 48078 | CO | Primary |
Addresses
Primary practice location
5920 McIntyre St
Golden, CO 80403-7445
Mailing address
5920 McIntyre St
Golden, CO 80403-7445
Phone (303) 949-1250
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 49378341 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121012000454 | CO | Practitioner - Family Practice | 4981853629 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48078 | CO | MD | Family Medicine Physician |
| BP10025451 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inpatient Consultants of Colorado, PC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Denver, CO
- NPI 1538461256
Family Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453680000000",
"number": "1417099490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5920 MCINTYRE ST",
"city": "GOLDEN",
"state": "CO",
"postal_code": "804037445",
"telephone_number": "303-949-1250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5920 MCINTYRE ST",
"city": "GOLDEN",
"state": "CO",
"postal_code": "804037445",
"telephone_number": "303-949-1250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESA",
"first_name": "GREGORY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2016-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "BP10025451",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "48078",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "49378341",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Golden, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; 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.