Boulder Biologics, LLC

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

License

47816 Issued in CO

Legal business name

BOULDER BIOLOGICS, LLC

Practice address

4745 Arapahoe Ave Ste 300
Boulder, CO 80303-1292

Phone

(720) 550-6175

NPI assigned

Jul 18, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jason Wells Glowney, MD

Title

President

Phone

(720) 550-6175

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Boulder Biologics, LLC Doing business as

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18118/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1477039907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 ARAPAHOE AVE STE 300",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031292",
            "telephone_number": "720-550-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 ARAPAHOE AVE STE 300",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031292",
            "telephone_number": "720-550-6175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER BIOLOGICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "GLOWNEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "WELLS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "720-550-6175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "CO",
            "license": "47816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER FOR JASON GLOWNEY",
            "identifier": "1922264175",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Biologics, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sports Medicine (Internal Medicine) Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Sports Medicine (Internal Medicine) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.