NPIMap

Organization Active NPI

Intermountain Medical Group Denver, LLC

Doing business as Broomfield Clinic

  • Family Medicine Physician
  • Broomfield, CO
National Provider Identifier
1497367213
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INTERMOUNTAIN MEDICAL GROUP DENVER, LLC
Doing business as
Broomfield Clinic
Practice address
12169 Sheridan Blvd
Broomfield, CO 80020-2459
Phone
(303) 603-9400
Fax
(303) 603-9420
NPI assigned
Aug 21, 2020
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Jon McDaniel
Title
VP Finance
Phone
(303) 272-0231

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Occupational Medicine Physician 2083X0100X NU

Addresses

Primary practice location

12169 Sheridan Blvd
Broomfield, CO 80020-2459

Mailing address

500 Eldorado Blvd Ste 6300
Broomfield, CO 80021-3422
Phone (303) 272-0566

Other names 3

  • Broomfield Clinic Doing business as
  • Broomfield Clinic Occupational Therapy Other name
  • Broomfield Clinic Physical Therapy Other name

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
06D1051480Broomfield Clinic12169 Sheridan Blvd, Broomfield, CO 80020Certificate of waiverJan 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
SCL Health Medical Group121 organizations share this tax ID, including this one
Part of
Exempla Healthcare

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

NPI Registry JSON

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

{
    "created_epoch": "1597968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1497367213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 6300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213422",
            "telephone_number": "303-272-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12169 SHERIDAN BLVD",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800202459",
            "telephone_number": "303-603-9400",
            "fax_number": "303-603-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP DENVER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2020-08-21",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broomfield Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Broomfield Clinic Occupational Therapy",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Broomfield Clinic Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.