NPIMap

Organization Active NPI

Colorado Pain Practice, PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Lakewood, CO
National Provider Identifier
1508285776
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
COLORADO PAIN PRACTICE, PLLC
Practice address
12596 W Bayaud Ave Ste 350
Lakewood, CO 80228-2019
Phone
(303) 468-7246
Fax
(303) 277-0714
NPI assigned
Apr 15, 2014
Last updated
Jan 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Authorized official

Name
Robert MoghimNPI 1245282862
Title
Ceo
Phone
(303) 282-1520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary

Addresses

Primary practice location

12596 W Bayaud Ave Ste 350
Lakewood, CO 80228-2019

Mailing address

1355 South Colorado Boulevard
Suite 700
Denver, CO 80222
Phone (303) 282-1520

Other names 1

  • Colorado Pain Practice, PLLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170324000399 CO Part B Supplier - Clinic/Group Practice 6709161292 Receives reassigned benefits from 31 practitioners
5 other NPIs on this enrollment
Practice locations: Castle Rock, CO; Denver, CO; Lakewood, CO; Loveland, CO

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

1355 S Colorado Blvd
Ste 700
Denver, CO 80222
Phone (303) 277-0700

2696 S Colorado Blvd
Ste 240
Denver, CO 80222
Phone (210) 213-4444

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641168000000",
    "number": "1508285776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 SOUTH COLORADO BOULEVARD",
            "address_2": "SUITE 700",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80222",
            "telephone_number": "303-282-1520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12596 W BAYAUD AVE STE 350",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282019",
            "telephone_number": "303-468-7246",
            "fax_number": "303-277-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO PAIN PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A",
        "authorized_official_last_name": "MOGHIM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "303-282-1520"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colorado Pain Practice, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lakewood, CO

Sources for this page

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