Individual provider Active NPI

Timothy Stidham, MD

  • Pediatric Critical Care Medicine Physician
  • Aurora, CO
National Provider Identifier
1548460504
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
MD2019-0698 Issued in NM
Practice address
13123 E 16TH Ave
Aurora, CO 80045-7106
Phone
(720) 777-1234
NPI assigned
Jul 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 59214 MT
Pediatric Critical Care Medicine Physician 2080P0203X MD2019-0698 NM Primary
Pediatrics Physician 208000000X 48502 CO
Pediatric Critical Care Medicine Physician 2080P0203X 48502 CO

Addresses

Primary practice location

13123 E 16TH Ave
Aurora, CO 80045-7106

Mailing address

PO Box 110429
Aurora, CO 80042-0429

Other practice location 1

310 Sunnyview Ln
Kalispell, MT 59901-3129
Phone (406) 751-5310

Other identifiers 1

IdentifierTypeStateIssuer
43622771MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, MT, NM, IL, TX5 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20101018000530 CO Practitioner - Critical Care (Intensivists)Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 7911190475 Reassigns benefits to 2 organizations
I20180615002387 MT Practitioner - Pediatric Medicine 7911190475 Reassigns benefits to 1 organization
I20191107002838 NM Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 7911190475 Reassigns benefits to 1 organization
I20250506001344 IL Practitioner - Pediatric Medicine 7911190475 Reassigns benefits to 1 organization
I20260312000165 TX Practitioner - Pediatric Medicine 7911190475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2007
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4000 Ambassador Dr
Anchorage, AK 99508-5909

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48502COMDPediatric Critical Care Medicine Physician
59214MTMDPediatric Critical Care Medicine Physician
MD2019-0698NMMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Oct 9, 2024 Accepting new patients
Denver Health and Hospital Authority CurrentSince Apr 26, 2018 Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Feb 16, 2026 Accepting new patients
Kalispell Regional Medical Center, Inc CurrentSince Aug 1, 2018 Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Aug 1, 2018 Accepting new patients
Ou Health Partners, Inc CurrentSince Oct 9, 2024 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
University Physicians Incorporated CurrentSince Jul 15, 2023 Accepting new patients
Unm Medical Group Inc CurrentSince Sep 21, 2019 Accepting new patients
Denver Health and Hospital Authority CurrentSince Apr 26, 2018 Accepting new patients
Unm Medical Group, Inc. CurrentSince Sep 21, 2019 Accepting new patients
Carle Health Care Incorporated Family Medicine CurrentSince May 2, 2025 Accepting new patients
Kalispell Regional Medical Center Inc Past Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients

Locations

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

777 Bannock St
Denver, CO 80204

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

933 Bradbury Dr SE
Ste 2222
Albuquerque, NM 87106
Phone (505) 272-1476

2211 Lomas Blvd NE
Unm, NM 87106
Phone (505) 272-1111

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org
  • Direct secure messaging: tstidhammd440830@carlehiedirect.net
  • Direct secure messaging: tstidham139114@direct.dhha.org

Organizations & group practices 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1548460504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13123 E 16TH AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800457106",
            "telephone_number": "720-777-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 Sunnyview Ln",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013129",
            "country_code": "US",
            "telephone_number": "406-751-5310",
            "fax_number": "406-751-3068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-18",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MT",
            "license": "59214",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NM",
            "license": "MD2019-0698",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "48502",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "CO",
            "license": "48502",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43622771",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "310 Sunnyview Ln",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.