NPIMap

Organization Active NPI

Colorado Retina Associates, PLLC

  • Medical Specialty Clinic/Center
  • Englewood, CO
National Provider Identifier
1497389399
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
COLORADO RETINA ASSOCIATES, PLLC
Practice address
850 Englewood Pkwy Ste 200
Englewood, CO 80110-7399
Phone
(303) 261-1600
Fax
(303) 261-1601
NPI assigned
Feb 28, 2020
Last updated
Jun 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
COLORADO RETINA ASSOCIATES, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Authorized official

Name
Kylie Wakasugi
Title
Credentialing Specialist
Phone
(303) 261-1600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary
Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician 207WX0108X
Retina Specialist (Ophthalmology) Physician 207WX0107X

Addresses

Primary practice location

850 Englewood Pkwy Ste 200
Englewood, CO 80110-7399

Mailing address

PO Box 17949
Denver, CO 80217-0949
Phone (303) 261-1600

Other practice location 1

360 Peak One Dr Ste 300
Frisco, CO 80443-5948
Phone (303) 261-1600

Other practice location 2

1050 W South Boulder Rd Ste 2100
Lafayette, CO 80026-2818
Phone (303) 261-1600

Other practice location 3

3401 Quebec St # 105
Denver, CO 80207-2322
Phone (303) 261-1600

Other practice location 4

255 S Routt St Ste 200
Lakewood, CO 80228-2271
Phone (303) 261-1600

Other practice location 5

11960 Lioness Way
Parker, CO 80134-5640
Phone (303) 261-1600

Other practice location 6

220 W 2nd St
Goodland, KS 67735-1602
Phone (303) 261-1600

Other identifiers 6

IdentifierTypeStateIssuer
74505807MedicaidCO
9000165843MedicaidCO
9000176494MedicaidCO
9000190491MedicaidCO
9000197544MedicaidCO
9000171077MedicaidCO

Other names 1

  • Colorado Retina Associates, PC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070125000355 CO Part B Supplier - Clinic/Group Practice 6002817566 Receives reassigned benefits from 15 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Denver, CO; Parker, CO; Littleton, CO; Lakewood, CO; Lafayette, CO; Golden, CO; Frisco, CO; Englewood, CO

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Colorado Retina Assoc PC9 organizations share this tax ID, including this one
Part of
Colorado Retina Assoc PC

Other organizations with this tax ID 8

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

Locations

3401 Quebec St
Ste 105
Denver, CO 80207

8101 E Lowry Blvd
Ste 210
Denver, CO 80230
Phone (720) 321-3550

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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": "1582848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1497389399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17949",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802170949",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 ENGLEWOOD PKWY STE 200",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801107399",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "360 Peak One Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Frisco",
            "state": "CO",
            "postal_code": "804435948",
            "country_code": "US",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 W South Boulder Rd Ste 2100",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "CO",
            "postal_code": "800262818",
            "country_code": "US",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 Quebec St # 105",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802072322",
            "country_code": "US",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "255 S Routt St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "CO",
            "postal_code": "802282271",
            "country_code": "US",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11960 Lioness Way",
            "address_purpose": "LOCATION",
            "city": "Parker",
            "state": "CO",
            "postal_code": "801345640",
            "country_code": "US",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "220 W 2nd St",
            "address_purpose": "LOCATION",
            "city": "Goodland",
            "state": "KS",
            "postal_code": "677351602",
            "country_code": "US",
            "telephone_number": "303-261-1600",
            "fax_number": "303-261-1601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COLORADO RETINA ASSOCIATES, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLORADO RETINA ASSOCIATES, PLLC",
        "enumeration_date": "2020-02-28",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "WAKASUGI",
        "authorized_official_first_name": "KYLIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "303-261-1600"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207WX0108X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Uveitis and Ocular Inflammatory Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74505807",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000165843",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000176494",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000190491",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000197544",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000171077",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colorado Retina Associates, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Englewood, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; 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.