NPIMap

Organization Active NPI

Denver Neurological Clinic Professional LLC

  • Clinical Neurophysiology Physician
  • Lone Tree, CO
National Provider Identifier
1578744017
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Neurophysiology PhysicianTaxonomy code 2084N0600X
License
42593 Issued in CO
Legal business name
DENVER NEUROLOGICAL CLINIC PROFESSIONAL LLC
Practice address
9980 Park Meadows Dr Ste 100
Lone Tree, CO 80124-8404
Phone
(303) 715-9024
Fax
(303) 715-7057
NPI assigned
Nov 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Authorized official

Name
Dr. Justin Moon, MDNPI 1215019609
Title
Managing Member
Phone
(303) 715-9024

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
Clinical Neurophysiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0600X 42593 CO Primary

Addresses

Primary practice location

9980 Park Meadows Dr Ste 100
Lone Tree, CO 80124-8404

Mailing address

9980 Park Meadows Dr Ste 100
Lone Tree, CO 80124-8404
Phone (303) 715-9024

Other identifiers 2

IdentifierTypeStateIssuer
10733850MedicaidCO
P00361949OtherCORAILROAD MEDICARE

Other names 1

  • Adam J. Wolff MD LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051220000495 CO Part B Supplier - Clinic/Group Practice 1456372770 Receives reassigned benefits from 9 practitioners
Practice locations: Denver, CO; Lone Tree, CO

National Provider Directory

National Provider Directory

Locations

2480 S Downing St
Ste 250
Denver, CO 80210
Phone (303) 698-9141

9980 Park Meadows Dr
Ste 100
Lone Tree, CO 80124
Phone (303) 715-9024

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1578744017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9980 PARK MEADOWS DR STE 100",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801248404",
            "telephone_number": "303-715-9024",
            "fax_number": "303-715-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9980 PARK MEADOWS DR STE 100",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801248404",
            "telephone_number": "303-715-9024",
            "fax_number": "303-715-7057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENVER NEUROLOGICAL CLINIC PROFESSIONAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-26",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "303-715-9024",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "CO",
            "license": "42593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10733850",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00361949",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adam J. Wolff MD LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Adam J. Wolff MD LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lone Tree, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; 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.