Ian R Tullberg, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

48313 Issued in CO

Practice address

2767 Janitell Rd
Colorado Springs, CO 80906-4102

Phone

(719) 365-2889

NPI assigned

Jun 15, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 26)

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.

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868
  Medicare reassignment Care Compare group NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260
  NPD
• Uch-MHS

  • Ambulance
  • Colorado Springs, CO
  • NPI 1417512559
  NPD (past)
• Uchealth Community Services

  • Physical Therapist
  • Englewood, CO
  • NPI 1841740693
  NPD (past)

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

• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1073172201
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1124518113
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1144397134
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1154030732
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Fountain, CO
  • NPI 1295225274
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1316506231
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1407532559
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1518526441
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1538958400
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1578053567
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1598324428
  Care Compare affiliation
• Uch-MHS

  • General Acute Care Hospital
  • Colorado Springs, CO
  • NPI 1629746599
  Care Compare affiliation

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469664000000",
    "number": "1457556052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE",
            "address_2": "STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-624-4036",
            "fax_number": "970-490-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2767 JANITELL RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809064102",
            "telephone_number": "719-365-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLBERG",
        "first_name": "IAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-15",
        "last_updated": "2016-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "48313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01282751",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea Tuff
• Deborah Sue-Perantoni Tuffield, NP
• Siena Tugendrajch, PHD
• Rylee Ann Tuggle
• Debra Ann Tulanowski, PMHNP-BC
• Justin Tullis, D.D.S
• Laura Tullis, APRN
• Phyllis Tully, LPCC
• Bretina Asiana Tumblin
• Kristine Tunehorst, PT

• Family Medicine Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.
• 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.