NPIMap

Individual provider Active NPI

Cheryl Brudos Wills, D.O.

  • Family Medicine Physician
  • Pueblo, CO
National Provider Identifier
1609931013
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30639 Issued in CO
Practice address
4020 Jerry Murphy Rd
Pueblo, CO 81001-1045
Phone
(719) 546-3600
Fax
(719) 546-0931
NPI assigned
Dec 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30639 CO Primary

Addresses

Primary practice location

4020 Jerry Murphy Rd
Pueblo, CO 81001-1045

Mailing address

4020 Jerry Murphy Rd
Pueblo, CO 81001-1045
Phone (719) 546-3600

Other identifiers 1

IdentifierTypeStateIssuer
01306398MedicaidCO

Other names 1

  • Dr. Cheryl Brudos Former name

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
I20120516000160 CO Practitioner - Family Practice 9537240965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Family Medicine Center, P.C.Group PAC ID 9739157827, 7 clinicians

Practice addresses (Care Compare)

4020 Jerry Murphy Rd
Pueblo, CO 81001-1045
Phone (719) 546-3600

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Colorado Springs, CO, CCN 067129
  • Parkview Medical Center, Inc Hospital, Pueblo, CO, CCN 060020
  • St Mary-Corwin Hospital Hospital, Pueblo, CO, CCN 060012

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30639COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Family Medicine Center, P.C. Family Medicine CurrentSince Apr 1, 2001 Accepting new patients

Locations

4020 Jerry Murphy Rd
Pueblo, CO 81001
Phone (719) 546-3600

Interoperability endpoints

  • Direct secure messaging: cheryl.wills.1@6060.direct.athenahealth.com

Organizations & group practices 1

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 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330300800000",
    "number": "1609931013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 JERRY MURPHY RD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011045",
            "telephone_number": "719-546-3600",
            "fax_number": "719-546-0931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 JERRY MURPHY RD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011045",
            "telephone_number": "719-546-3600",
            "fax_number": "719-546-0931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "CHERYL",
        "middle_name": "BRUDOS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-26",
        "last_updated": "2012-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "30639",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01306398",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHERYL",
            "last_name": "BRUDOS",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.