NPIMap

Organization Active NPI

Magnolia Medical Company

  • Addiction Medicine (Internal Medicine) Physician
  • Wheat Ridge, CO
National Provider Identifier
1477271997
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
Legal business name
MAGNOLIA MEDICAL COMPANY
Practice address
10160 W 50TH Ave Unit 4
Wheat Ridge, CO 80033-2339
Phone
(303) 209-5115
Fax
(720) 638-5562
NPI assigned
Aug 19, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Authorized official

Name
Valerie Lavoie
Title
Practice Manager
Phone
(303) 209-5115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X Primary

Addresses

Primary practice location

10160 W 50TH Ave Unit 4
Wheat Ridge, CO 80033-2339

Mailing address

PO Box 29605
Dept # 800927
Phoenix, AZ 85038-9605
Phone (303) 209-5115

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171211000760 CO Part B Supplier - Clinic/Group Practice 0749548253 Receives reassigned benefits from 45 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wheat Ridge, CO; Denver, CO

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
06D2043858Magnolia Medical Group10160 W 50TH Ave #4, Wheat Ridge, CO 80033Certificate of waiverFeb 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Medical Company4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4990 Kipling St
#B5
Wheat Ridge, CO 80033

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771286400000",
    "number": "1477271997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29605",
            "address_2": "DEPT # 800927",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850389605",
            "telephone_number": "303-209-5115",
            "fax_number": "720-638-5562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10160 W 50TH AVE UNIT 4",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800332339",
            "telephone_number": "303-209-5115",
            "fax_number": "720-638-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA MEDICAL COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-19",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A",
        "authorized_official_last_name": "LAVOIE",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "303-209-5115"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; 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.