NPIMap

Individual provider Active NPI

Magdiel Trinidad Hernandez, M.D.

  • Vascular Surgery Physician
  • Colorado Springs, CO
National Provider Identifier
1609025204
Registry record updated Jun 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
DR.0054839 Issued in CO
Practice address
1400 E Boulder St Ste 600
Colorado Springs, CO 80909-5533
Phone
(719) 364-6487
NPI assigned
Sep 18, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036114906 IL
Vascular Surgery Physician 2086S0129X 104331 MN
Vascular Surgery Physician 2086S0129X 45194 AZ
Vascular Surgery Physician 2086S0129X DR.0054839 CO Primary

Addresses

Primary practice location

1400 E Boulder St Ste 600
Colorado Springs, CO 80909-5533

Mailing address

2222 N Nevada Ave
Suite 5011
Colorado Springs, CO 80907-6819
Phone (719) 776-6700

Other practice location 1

2222 N Nevada Ave
Suite 5011
Colorado Springs, CO 80907-6819
Phone (719) 776-6700

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
I20150303001784 CO Practitioner - Vascular SurgeryPractitioner - General Surgery 0042363772 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder St
Suite 600 Uchmg General and Vascular Surgery
Colorado Springs, CO 80909-5533
Phone (719) 364-6487

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036114906ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Surgery CurrentSince Jun 13, 2018 Accepting new patients
Uchealth Imaging Services, LLC CurrentSince Apr 1, 2021 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Jun 13, 2018 Accepting new patients
Uchealth Imaging Services, LLC Current Accepting new patients
Uchealth Imaging Services, LLC CurrentSince Apr 1, 2021 Accepting new patients
Uch-MHS Past Accepting new patients
Banner-University Medical Group Family Medicine Past Accepting new patients

Locations

875 W 136th Ave
Ste 100
Broomfield, CO 80023
Phone (303) 457-7700

11820 Destination Dr
Broomfield, CO 80021
Phone (303) 460-6000

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

8890 N Union Blvd
Colorado Springs, CO 80920
Phone (719) 364-5633

4110 Briargate Pkwy
Ste 400
Colorado Springs, CO 80920
Phone (719) 364-6550

1400 E Boulder St
Ste 600
Colorado Springs, CO 80909
Phone (719) 364-6487

3843 Rio Vista Dr
Ste 2100
Colorado Springs, CO 80917
Phone (719) 364-5250

100 Cook St
Ste 410
Denver, CO 80206
Phone (720) 516-9420

328 S Bonaventure Ave
Ste 2
Trinidad, CO 81082
Phone (719) 364-6487

Organizations & group practices 7

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.

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": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591142400000",
    "number": "1609025204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 N NEVADA AVE",
            "address_2": "SUITE 5011",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076819",
            "telephone_number": "719-776-6700",
            "fax_number": "719-776-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E BOULDER ST STE 600",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095533",
            "telephone_number": "719-364-6487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 N Nevada Ave",
            "address_2": "SUITE 5011",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809076819",
            "country_code": "US",
            "telephone_number": "719-776-6700",
            "fax_number": "719-776-6780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRINIDAD HERNANDEZ",
        "first_name": "MAGDIEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-18",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036114906",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MN",
            "license": "104331",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "45194",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CO",
            "license": "DR.0054839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.