NPIMap

Organization Active NPI

Mind Body Sport, LLC

  • Professional Counselor
  • Denver, CO
National Provider Identifier
1497273916
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MIND BODY SPORT, LLC
Practice address
2121 S Oneida St Ste 600
Denver, CO 80224-2555
Phone
(720) 863-6100
NPI assigned
Sep 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

Name
Ian J Palombo, LPCNPI 1891223251
Title
President
Phone
(720) 863-6100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X

Addresses

Primary practice location

2121 S Oneida St Ste 600
Denver, CO 80224-2555

Mailing address

2121 S Oneida St Ste 600
Denver, CO 80224-2555
Phone (720) 863-6100

Other identifiers 1

IdentifierTypeStateIssuer
9000172843MedicaidCO

Other names 1

  • Denver Mental Health Collective Doing business as

National Provider Directory

National Provider Directory

Locations

2121 S Oneida St
Ste 600
Denver, CO 80224
Phone (720) 863-6100

Practitioners & affiliated clinicians

Practitioners 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1497273916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 S ONEIDA ST STE 600",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802242555",
            "telephone_number": "720-863-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S ONEIDA ST STE 600",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802242555",
            "telephone_number": "720-863-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY SPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-05",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "PALOMBO",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "720-863-6100",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000172843",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Denver Mental Health Collective",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Denver Mental Health Collective",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; 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.