NPIMap

Organization Active NPI

Banner Fort Collins PCP LLC

  • Primary Care Clinic/Center
  • Fort Collins, CO
National Provider Identifier
1497545685
Registry record updated Jul 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BANNER FORT COLLINS PCP LLC
Practice address
1113 Oakridge Dr
Fort Collins, CO 80525-5591
Phone
(970) 449-0961
NPI assigned
May 9, 2025
Organization subpart
Yes
Parent organization
BANNER MEDICAL GROUP COLORADOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2025

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

Authorized official

Name
Shiva Birdi, MD
Title
Ceo
Phone
(602) 747-4000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1113 Oakridge Dr
Fort Collins, CO 80525-5591

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

National Provider Directory

National Provider Directory
Tax ID family
Banner Health Physicians46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753833600000",
    "number": "1497545685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 OAKRIDGE DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805255591",
            "telephone_number": "970-449-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER FORT COLLINS PCP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER MEDICAL GROUP COLORADO",
        "enumeration_date": "2025-05-09",
        "last_updated": "2025-07-30",
        "certification_date": "2025-07-30",
        "status": "A",
        "authorized_official_last_name": "BIRDI",
        "authorized_official_first_name": "SHIVA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-747-4000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2025; 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.