NPIMap

Organization Active NPI

Pueblo Bone and Joint Clinic LLC

  • Orthopaedic Surgery Physician
  • Pueblo, CO
National Provider Identifier
1568534642
Registry record updated Apr 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
PUEBLO BONE AND JOINT CLINIC LLC
Practice address
1919 W US Highway 50
Pueblo, CO 81008-1618
Phone
(719) 253-7102
Fax
(719) 253-7114
NPI assigned
Nov 14, 2006
Last updated
Apr 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2017

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

Authorized official

Name
Annette Garcia
Title
Business Office Manager
Phone
(719) 253-7102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

1919 W US Highway 50
Pueblo, CO 81008-1618

Mailing address

1919 W US Highway 50
Pueblo, CO 81008-1618
Phone (719) 253-7102

Other identifiers 1

IdentifierTypeStateIssuer
50330349MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040122000940 CO Part B Supplier - Clinic/Group Practice 0244132066 Receives reassigned benefits from 4 practitioners
Practice locations: Pueblo, CO
O20100930023313 CO DME Supplier - Physician - Orthopedic/Orthopedic Surgery 0244132066 Practice locations: Pueblo, CO

National Provider Directory

National Provider Directory

Locations

1919 W US Highway 50
Pueblo, CO 81008
Phone (719) 253-7102

Practitioners & affiliated clinicians

Practitioners 11

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1568534642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 W US HIGHWAY 50",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081618",
            "telephone_number": "719-253-7102",
            "fax_number": "719-253-7114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 W US HIGHWAY 50",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081618",
            "telephone_number": "719-253-7102",
            "fax_number": "719-253-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO BONE AND JOINT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "719-253-7102"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50330349",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; 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.