NPIMap

Individual provider Active NPI

Landrey Fagan, MD

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1548423817
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0060345 Issued in CO
Practice address
3434 47TH St Ste 225
Boulder, CO 80301-1880
Phone
(720) 792-2852
Fax
(303) 586-7592
NPI assigned
Jul 8, 2008
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR0060345 CO
Hospitalist Physician 208M00000X DR.0060345 CO
Family Medicine Physician 207Q00000X DR.0060345 CO Primary
Family Medicine Physician 207Q00000X 246674 MA

Addresses

Primary practice location

3434 47TH St Ste 225
Boulder, CO 80301-1880

Mailing address

1950 Mountain View Ave
Longmont, CO 80501-3129
Phone (303) 651-5111

Other practice location 1

1950 Mountain View Ave
Longmont, CO 80501-3129
Phone (303) 651-5111

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
I20180905002457 CO Practitioner - HospitalistPractitioner - General PracticePractitioner - Family Practice 9537339718 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Georgetown University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians
Select Physical Therapy of West Denver Limited PartnershipGroup PAC ID 6709771157, shared by 5 NPIs, 530 clinicians
Four Mile Creek HealthGroup PAC ID 3375063704, 2 clinicians

Practice addresses (Care Compare)

1950 Mountain View Ave
Longmont, CO 80501-3129
Phone (303) 651-5300

3434 47TH St
Boulder, CO 80301-1817
Phone (303) 376-0184

3434 47TH St
Suite 225
Boulder, CO 80301-1801
Phone (720) 792-2852

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR0060345COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Four Mile Creek Health Family Medicine CurrentSince Jan 20, 2025 Accepting new patients
Catholic Health Initiatives Colorado Current Accepting new patients
Catholic Health Initiatives Colorado Family Medicine CurrentSince Jan 4, 2021 Accepting new patients
Portercare Adventist Health System CurrentSince Jan 4, 2021 Accepting new patients
Portercare Adventist Health System Current Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Jan 4, 2021 Accepting new patients
Portercare Adventist Health System CurrentSince Jan 4, 2021 Accepting new patients
Portercare Adventist Health System Past Accepting new patients

Locations

3434 47th St
Ste 225
Boulder, CO 80301
Phone (720) 792-2842

7750 S Broadway
Ste 260
Littleton, CO 80122
Phone (303) 734-8650

1950 Mountain View Ave
Longmont, CO 80501
Phone (303) 651-5000

2030 Mountain View Ave
Ste 540
Longmont, CO 80501
Phone (303) 651-5302

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Interoperability endpoints

  • Direct secure messaging: landrey.fagan@1097934349729796.direct.elationemr.com

Organizations & group practices 8

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 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1548423817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 MOUNTAIN VIEW AVE",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013129",
            "telephone_number": "303-651-5111",
            "fax_number": "303-678-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 47TH ST STE 225",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011880",
            "telephone_number": "720-792-2852",
            "fax_number": "303-586-7592"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1950 Mountain View Ave",
            "address_purpose": "LOCATION",
            "city": "Longmont",
            "state": "CO",
            "postal_code": "805013129",
            "country_code": "US",
            "telephone_number": "303-651-5111",
            "fax_number": "303-678-4050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "LANDREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-08",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR0060345",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CO",
            "license": "DR.0060345",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0060345",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "246674",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.