NPIMap

Organization Active NPI

Optumcare Colorado Medical Group LLC

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1487285383
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP LLC
Practice address
3470 Centennial Blvd Ste 215
Colorado Springs, CO 80907-4090
Phone
(719) 635-3355
Fax
(719) 635-3366
NPI assigned
Jan 29, 2020
Organization subpart
Yes
Parent organization
OPTUMCARE COLORADO MEDICAL GROUP LLCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Emily Castillo
Title
Associate Director Credentialing
Phone
(702) 579-3253

Other NPIs on the same Medicare enrollment 16

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

View all 16

Practitioners 20

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

View all 20

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150129000413 CO Part B Supplier - Clinic/Group Practice 2769706431 Receives reassigned benefits from 386 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Littleton, CO; Evergreen, CO; Golden, CO; Highlands Ranch, CO; Lakewood, CO; Aurora, CO; Lone Tree, CO; Longmont, CO…

National Provider Directory

National Provider Directory
Tax ID family
Davita Med GRP Co Springs61 organizations share this tax ID, including this one
Part of
Davita Med GRP Co Springs

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3470 Centennial Blvd
Ste 215
Colorado Springs, CO 80907
Phone (719) 635-3355

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

3470 Centennial Blvd Ste 215
Colorado Springs, CO 80907-4090

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other names 1

NPPES NPI Registry
  • MDVIP DR MICHAEL YOESEL Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 20, 2024.

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1487285383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203",
            "fax_number": "719-538-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3470 CENTENNIAL BLVD STE 215",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809074090",
            "telephone_number": "719-635-3355",
            "fax_number": "719-635-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "enumeration_date": "2020-01-29",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "702-579-3253"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MDVIP DR MICHAEL YOESEL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MDVIP DR MICHAEL YOESEL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.