NPIMap

Individual provider Active NPI

Charlotte L Ellenbogen, D.O.

  • Infectious Disease Physician
  • Wheat Ridge, CO
National Provider Identifier
1417914540
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
53322 Issued in CO
Practice address
3885 Upham St
Suite 200
Wheat Ridge, CO 80033-4880
Phone
(303) 425-9245
Fax
(303) 425-1378
NPI assigned
May 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X 53322 CO Primary

Addresses

Primary practice location

3885 Upham St
Suite 200
Wheat Ridge, CO 80033-4880

Mailing address

PO Box 1449
Wheat Ridge, CO 80034-1449
Phone (303) 425-9245

Other identifiers 1

IdentifierTypeStateIssuer
03611509MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cellenbogen@widc.careclouddirect.com Health Information Exchange (HIE)

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
I20140717002127 CO Practitioner - Infectious Disease 0547271900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3885 Upham St
Suite 200
Wheat Ridge, CO 80033-4800
Phone (303) 425-9245

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53322COMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Western Infectious Disease Consultants, P.C. Infectious Disease CurrentSince Jul 1, 2014 Accepting new patients
Western Infectious Disease Consultants, P.C. Infectious Disease CurrentSince Jul 1, 2014 Accepting new patients
Western Infectious Disease Infusion Center, Inc Infectious Disease Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

3303 W 144th Ave
Unit 103
Broomfield, CO 80023
Phone (303) 425-9245

1536 Cole Blvd
Ste 120
Lakewood, CO 80401
Phone (303) 423-8334

3885 Upham St
Ste 200
Wheat Ridge, CO 80033
Phone (303) 425-9245

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1417914540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800341449",
            "telephone_number": "303-425-9245",
            "fax_number": "303-425-1378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3885 UPHAM ST",
            "address_2": "SUITE 200",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334880",
            "telephone_number": "303-425-9245",
            "fax_number": "303-425-1378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLENBOGEN",
        "first_name": "CHARLOTTE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-01",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CO",
            "license": "53322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03611509",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cellenbogen@widc.careclouddirect.com",
            "affiliation": "N",
            "endpointDescription": "CEllenbogen WIDC Direct Email Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "3885 Upham St",
            "address_2": "SUITE 200",
            "city": "Wheat Ridge",
            "state": "CO",
            "country_code": "US",
            "postal_code": "800334880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.