NPIMap

Individual provider Active NPI

Shane August Juenemann, M.D.

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1437138369
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42518 Issued in CO
Practice address
6685 Gunpark Dr Ste 110
Boulder, CO 80301-3343
Phone
(303) 530-3062
Fax
(303) 530-5474
NPI assigned
Jan 10, 2006
Last updated
Nov 9, 2017By the provider in NPPES
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
Family Medicine Physician 207Q00000X 42518 CO Primary

Addresses

Primary practice location

6685 Gunpark Dr Ste 110
Boulder, CO 80301-3343

Mailing address

5450 Western Ave
Suite B
Boulder, CO 80301-2709
Phone (303) 415-7599

Other identifiers 1

IdentifierTypeStateIssuer
58634266MedicaidCO

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
I20070521000176 CO Practitioner - Family PracticePractitioner - Sports MedicinePractitioner - Other (Physician) 7517933070 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Pennsylvania State University College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

Broomfield, CO 80021
Phone (720) 807-4461

3 Superior Dr
Suite 400
Superior, CO 80027-8656
Phone (303) 673-1440

8350 Colorado Blvd
Unit 160
Firestone, CO 80504-6803
Phone (303) 673-1370

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42518COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC Family Medicine Current Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 31, 2021 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 31, 2021 Accepting new patients
Rocky Mountain Primary Care , PC Family Medicine Past Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

3 Superior Dr
Ste 400
Superior, CO 80027
Phone (303) 673-1440

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510185600000",
    "number": "1437138369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE",
            "address_2": "SUITE B",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-415-7599",
            "fax_number": "303-530-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6685 GUNPARK DR STE 110",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803013343",
            "telephone_number": "303-530-3062",
            "fax_number": "303-530-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUENEMANN",
        "first_name": "SHANE",
        "middle_name": "AUGUST",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2017-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "42518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58634266",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.