NPIMap

Organization Active NPI

Optumcare Colorado Medical Group, LLC

  • Clinical Medical Laboratory
  • Colorado Springs, CO
National Provider Identifier
1619009388
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP, LLC
Practice address
1633 Medical Center PT
Colorado Springs, CO 80907-1604
Phone
(719) 667-4146
Fax
(719) 520-5266
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Authorized official

Name
Emily Castillo
Title
Associate Director Credentialing
Phone
(702) 480-2550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1633 Medical Center PT
Colorado Springs, CO 80907-1604

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other names 4

  • Optum Colorado Springs Doing business as
  • Colorado Springs Health Partners LLC Former legal business name
  • DaVita Medical Group Colorado Springs LLC Former legal business name
  • OptumCare Colorado Springs 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
O20150729007266 CO Part B Supplier - Independent Clinical Laboratory 2769706431 Practice locations: Colorado Springs, CO

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0517327Optum Colorado - MCP Family Practice1633 Medical Center Point, Colorado Springs, CO 80907Certificate of waiverAug 31, 2027
06D1103201Optum Colorado - MCP Dermatology1633 Medical Center Point - Dermatology 2ND Floor, Colorado Springs, CO 80907ComplianceMay 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Davita Med GRP Co Springs61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1633 Medical Center Pt
Fl 1
Colorado Springs, CO 80907
Phone (719) 667-4146

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1619009388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203",
            "fax_number": "719-538-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 MEDICAL CENTER PT",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809071604",
            "telephone_number": "719-667-4146",
            "fax_number": "719-520-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "702-480-2550"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum Colorado Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Springs Health Partners LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "DaVita Medical Group Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "OptumCare Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.