NPIMap

Individual provider Active NPI

Jeremy Michael Raulie, PAC

  • Surgical Physician Assistant
  • Colorado Springs, CO
National Provider Identifier
1538113105
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
CO1776 Issued in CO
Practice address
2446 Research Pkwy
Suite 200
Colorado Springs, CO 80920-1087
Phone
(719) 623-1050
Fax
(719) 623-1052
NPI assigned
May 19, 2006
Last updated
Nov 7, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X CO1776 CO
Medical Physician Assistant 363AM0700X CO1776 CO
Surgical Physician Assistant 363AS0400X CO1776 CO Primary

Addresses

Primary practice location

2446 Research Pkwy
Suite 200
Colorado Springs, CO 80920-1087

Mailing address

2446 Research Pkwy
Suite 200
Colorado Springs, CO 80920-1087
Phone (719) 623-1050

Other identifiers 1

IdentifierTypeStateIssuer
46559043MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070917000544 CO Practitioner - Physician Assistant 5395839757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians

Practice addresses (Care Compare)

1263 Lake Plaza Dr
Suite 210
Colorado Springs, CO 80906-3511
Phone (719) 623-1050

1411 S Potomac St
350 Coc Arapahoe Sports Medicine and Rehab
Aurora, CO 80012-4543
Phone (303) 695-6060

2430 Research Pkwy
Colorado Springs, CO 80920-1093

2446 Research Pkwy
Suite 200
Colorado Springs, CO 80920-1087
Phone (719) 623-1050

406 E Grace Ave
Select Physical Therapy
Woodland Park, CO 80863-3127
Phone (719) 687-3767

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
43.24 of 100Reported as group
Quality
73.53
Promoting interoperability
0
Improvement activities
0
Cost
70.6

Merit-based Incentive Payment System (MIPS)

Final score
40.82 of 100Reported as group
Quality
9.1
Promoting interoperability
100
Improvement activities
0
Cost
43.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1776COMDAcupuncturist
CO1776COMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Centers of Colorado, LLC Physician Assistant CurrentSince Sep 1, 2019 Accepting new patients
Orthopedic Centers of Colorado, LLC Physician Assistant CurrentSince Sep 1, 2019 Accepting new patients

Locations

1411 S Potomac St
Ste 350
Aurora, CO 80012
Phone (303) 671-2134

1263 Lake Plaza Dr
Ste 210
Colorado Springs, CO 80906
Phone (719) 623-1050

2430 Research Pkwy
Ste 100
Colorado Springs, CO 80920
Phone (719) 623-1050

2430 Research Pkwy
Ste 205
Colorado Springs, CO 80920
Phone (505) 322-6687

2446 Research Pkwy
Ste 200
Colorado Springs, CO 80920
Phone (719) 623-1050

8101 E Lowry Blvd
Ste 120
Lowry, CO 80230
Phone (303) 806-1998

Interoperability endpoints

  • Direct secure messaging: jeremyraulie@occllc.allscriptsdirect.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415318400000",
    "number": "1538113105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2446 RESEARCH PKWY",
            "address_2": "SUITE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809201087",
            "telephone_number": "719-623-1050",
            "fax_number": "719-623-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2446 RESEARCH PKWY",
            "address_2": "SUITE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809201087",
            "telephone_number": "719-623-1050",
            "fax_number": "719-623-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAULIE",
        "first_name": "JEREMY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2014-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "CO1776",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "CO1776",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "CO1776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46559043",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.