NPIMap

Organization Active NPI

Pediatric Partners of the Southwest

  • Pediatrics Physician
  • Durango, CO
National Provider Identifier
1508041047
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
1083717219 Issued in CO
Legal business name
PEDIATRIC PARTNERS OF THE SOUTHWEST
Practice address
575 Rivergate
Suite 109
Durango, CO 81301-7487
Phone
(970) 375-0100
NPI assigned
Jan 3, 2008
Last updated
Jan 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

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

Authorized official

Name
Dr. Martha Cecile Fraley, MDNPI 1780701649
Title
Parner
Phone
(970) 375-0010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 1083717219 CO Primary

Addresses

Primary practice location

575 Rivergate
Suite 109
Durango, CO 81301-7487

Mailing address

575 Rivergate
Suite 109
Durango, CO 81301-7487
Phone (970) 375-0100

Other identifiers 1

IdentifierTypeStateIssuer
01188358MedicaidCO

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Partners of the Southwest PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1508041047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 RIVERGATE",
            "address_2": "SUITE 109",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017487",
            "telephone_number": "970-375-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 RIVERGATE",
            "address_2": "SUITE 109",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017487",
            "telephone_number": "970-375-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC PARTNERS OF THE SOUTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "FRALEY",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "CECILE",
        "authorized_official_title_or_position": "PARNER",
        "authorized_official_telephone_number": "970-375-0010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "1083717219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01188358",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; 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.