NPIMap

Organization Active NPI

Intermountain Front Range, Inc.

Doing business as Lutheran Weight Loss Clinic

  • Obesity Medicine (Internal Medicine) Physician
  • Lafayette, CO
National Provider Identifier
1609493576
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X
Legal business name
INTERMOUNTAIN FRONT RANGE, INC.
Doing business as
Lutheran Weight Loss Clinic
Practice address
300 Exempla Cir Ste 360
Lafayette, CO 80026-3395
Phone
(303) 403-3030
Fax
(303) 403-6907
NPI assigned
Jun 26, 2020
Last updated
Jul 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INTEGRITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Authorized official

Name
Sean Fadden
Title
VP Finance
Phone
(303) 425-2410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RB0002X Primary

Addresses

Primary practice location

300 Exempla Cir Ste 360
Lafayette, CO 80026-3395

Mailing address

500 Eldorado Blvd Ste 6300
Broomfield, CO 80021-3422
Phone (303) 272-0566

Other names 1

  • Lutheran Weight Loss Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000049 CO Part B Supplier - Clinic/Group Practice 6800799537 Receives reassigned benefits from 119 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Golden, CO; Wheat Ridge, CO

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719792000000",
    "number": "1609493576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ELDORADO BLVD STE 6300",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800213422",
            "telephone_number": "303-272-0566",
            "fax_number": "303-272-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 EXEMPLA CIR STE 360",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800263395",
            "telephone_number": "303-403-3030",
            "fax_number": "303-403-6907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRITY HEALTH",
        "enumeration_date": "2020-06-26",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A",
        "authorized_official_last_name": "FADDEN",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "303-425-2410"
    },
    "taxonomies": [
        {
            "code": "207RB0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lutheran Weight Loss Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lutheran Weight Loss Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.