NPIMap

Individual provider Active NPI

Kyle Jordan Marthaller, MD

  • Surgery Physician
  • Boulder, CO
National Provider Identifier
1417243254
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
DR.0056793 Issued in CO
Practice address
4743 Arapahoe Ave
Suite 100
Boulder, CO 80303-1113
Phone
(303) 443-2123
Fax
(303) 443-9497
NPI assigned
Jun 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X DR.0056793 CO Primary

Addresses

Primary practice location

4743 Arapahoe Ave
Suite 100
Boulder, CO 80303-1113

Mailing address

5450 Western Ave
Boulder, CO 80301-2709
Phone (303) 443-2123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160812001392 CO Practitioner - General Surgery 8022302033 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of North Dakota School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

1755 48TH St
Suite 200
Boulder, CO 80301-2712
Phone (303) 415-7450

4743 Arapahoe Ave
Suite 100
Boulder, CO 80303-1123
Phone (303) 443-2123

4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone (303) 415-7610

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)33
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue57
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Aug 1, 2016 Accepting new patients
Boulder Community Health CurrentSince Aug 1, 2016 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

4743 Arapahoe Ave
Ste 100
Boulder, CO 80303
Phone (303) 415-4599

5450 Western Ave
Boulder, CO 80301
Phone (303) 415-4770

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

101 Erie Pkwy
Ste 201G
Erie, CO 80516
Phone (303) 415-4599

Interoperability endpoints

  • Direct secure messaging: kmarthaller@bch.gwaydirect.com

Organizations & group practices 4

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 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1417243254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-443-2123",
            "fax_number": "303-443-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4743 ARAPAHOE AVE",
            "address_2": "SUITE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031113",
            "telephone_number": "303-443-2123",
            "fax_number": "303-443-9497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTHALLER",
        "first_name": "KYLE",
        "middle_name": "JORDAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-21",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "DR.0056793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.