NPIMap

Organization Active NPI

Vanguard Medical Specialists LLC

Doing business as Vanguard Skin Specialists

  • Dermatology Physician
  • La Junta, CO
National Provider Identifier
1497324297
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
VANGUARD MEDICAL SPECIALISTS LLC
Doing business as
Vanguard Skin Specialists
Practice address
1100 Carson Ave
La Junta, CO 81050-2751
Phone
(719) 355-1585
NPI assigned
Jun 24, 2021
Last updated
Apr 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Authorized official

Name
Amber Gust-Allen
Title
Revenue Cycle Manager
Phone
(719) 465-5643

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary
MOHS-Micrographic Surgery Physician 207ND0101X
Dermatopathology Physician 207ND0900X
Pediatric Dermatology Physician 207NP0225X
Procedural Dermatology Physician 207NS0135X
Facial Plastic Surgery Physician 207YS0123X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X
Plastic Surgery Physician 208200000X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X

Addresses

Primary practice location

1100 Carson Ave
La Junta, CO 81050-2751

Mailing address

PO Box 5088
Denver, CO 80217-5088
Phone (719) 355-1585

Other names 1

  • Vanguard Skin Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090616000804 CO Part B Supplier - Clinic/Group Practice 9436209285 Receives reassigned benefits from 26 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Canon City, CO; Woodland Park, CO; Pueblo, CO; La Junta, CO; Hugo, CO; Colorado Springs, CO; Castle Rock, CO

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Vanguard Medical Specialists LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

9348 Grand Cordera Pkwy
Ste 160
Colorado Springs, CO 80924

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1497324297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5088",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175088",
            "telephone_number": "719-355-1585",
            "fax_number": "719-623-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CARSON AVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502751",
            "telephone_number": "719-355-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANGUARD MEDICAL SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-24",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A",
        "authorized_official_last_name": "GUST-ALLEN",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "719-465-5643"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vanguard Skin Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vanguard Skin Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Junta, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.