NPIMap

Organization Active NPI

Spine West a Professional LLC

  • Physical Medicine & Rehabilitation Physician
  • Boulder, CO
National Provider Identifier
1427091206
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SPINE WEST A PROFESSIONAL LLC
Practice address
5387 Manhattan Circle
Suite 200
Boulder, CO 80303-4283
Phone
(303) 494-7773
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Authorized official

Name
David Rodriguez
Title
Practice Manager
Phone
(303) 494-7773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

5387 Manhattan Circle
Suite 200
Boulder, CO 80303-4283

Mailing address

5387 Manhattan Circle
Suite 200
Boulder, CO 80303-4283
Phone (303) 494-7773

Other names 1

  • Advanced Spine & Sports Specialists, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040615001792 CO Part B Supplier - Clinic/Group Practice 0749264968 Receives reassigned benefits from 16 practitioners
Practice locations: Boulder, CO; Wheat Ridge, CO
O20110510000358 CO DME Supplier - Physician - General Surgery 0749264968 Practice locations: Boulder, CO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D2001494Spine West LLC5387 Manhattan Cir Ste 200, Boulder, CO 80303Certificate of waiverSep 13, 2027

National Provider Directory

National Provider Directory

Locations

5387 Manhattan Cir
Ste 100
Boulder, CO 80303
Phone (303) 543-7676

5387 Manhattan Cir
Ste 100B
Boulder, CO 80303
Phone (303) 494-7733

5387 Manhattan Cir
Ste 200
Boulder, CO 80303
Phone (303) 494-1104

5387 Manhattan Cir
Boulder, CO 80303
Phone (303) 373-2008

90 Health Park Dr
Ste 370
Louisville, CO 80027
Phone (303) 666-9839

1475 Pine Grove Rd
Ste 108
Steamboat Springs, CO 80487

3555 Lutheran Pkwy
Ste 9
Wheat Ridge, CO 80033

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1427091206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5387 MANHATTAN CIRCLE",
            "address_2": "SUITE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034283",
            "telephone_number": "303-494-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5387 MANHATTAN CIRCLE",
            "address_2": "SUITE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034283",
            "telephone_number": "303-494-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE WEST A PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "303-494-7773"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Spine & Sports Specialists, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Advanced Spine & Sports Specialists, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.