Organization Active NPI

Peak Internal Medicine

  • Internal Medicine Physician
  • Louisville, CO
National Provider Identifier
1619452364
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PEAK INTERNAL MEDICINE
Practice address
400 S McCaslin Blvd Ste 200
Louisville, CO 80027-9701
Phone
(720) 222-0648
Fax
(720) 222-0654
NPI assigned
Sep 28, 2018
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Jennifer Tamblyn, MDNPI 1881860773
Title
Owner
Phone
(720) 272-9112

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
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

400 S McCaslin Blvd Ste 200
Louisville, CO 80027-9701

Mailing address

400 S McCaslin Blvd Ste 200
Superior, CO 80027-9701
Phone (720) 222-0648

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181109001913 CO Part B Supplier - Clinic/Group Practice 3678827672 Receives reassigned benefits from 3 practitioners
Practice locations: Superior, CO

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
06D2170302Peak Internal Medicine400 S McCaslin Blvd Suite 200, Louisville, CO 80027Provider-performed microscopyAug 6, 2027

National Provider Directory

National Provider Directory

Locations

400 S McCaslin Blvd
Ste 200
Superior, CO 80027
Phone (720) 222-0648

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1619452364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S MCCASLIN BLVD STE 200",
            "city": "SUPERIOR",
            "state": "CO",
            "postal_code": "800279701",
            "telephone_number": "720-222-0648",
            "fax_number": "720-222-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S MCCASLIN BLVD STE 200",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800279701",
            "telephone_number": "720-222-0648",
            "fax_number": "720-222-0654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-28",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "TAMBLYN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-272-9112",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.