NPIMap

Organization Active NPI

Poudre Valley Medical Group, LLC

Doing business as UCHealth Medical Group

  • Internal Medicine Physician
  • Fort Collins, CO
National Provider Identifier
1619577459
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
POUDRE VALLEY MEDICAL GROUP, LLC
Doing business as
UCHealth Medical Group
Practice address
4674 Snow Mesa Dr Ste 200
Fort Collins, CO 80528-8614
Phone
(970) 266-3650
Fax
(970) 266-3660
NPI assigned
Oct 30, 2020
Last updated
Aug 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
POUDRE VALLEY MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Jana Conroy
Title
Director of Credentialing
Phone
(970) 266-3650

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

4674 Snow Mesa Dr Ste 200
Fort Collins, CO 80528-8614

Mailing address

2695 Rocky Mountain Ave Ste 150
Loveland, CO 80538-9071
Phone (970) 266-3650

Other names 2

  • UCHealth Medical Group Doing business as
  • UCHealth Internal Medicine and Pediatric Care - Snow Mesa Other name

National Provider Directory

National Provider Directory
Tax ID family
Poudre Valley Med GRP LLC283 organizations share this tax ID, including this one
Part of
Poudre Valley Med GRP LLC

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

NPI Registry JSON

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1619577459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071",
            "telephone_number": "970-266-3650",
            "fax_number": "970-266-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4674 SNOW MESA DR STE 200",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805288614",
            "telephone_number": "970-266-3650",
            "fax_number": "970-266-3660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POUDRE VALLEY MEDICAL GROUP, LLC",
        "enumeration_date": "2020-10-30",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "970-266-3650"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCHealth Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHealth Internal Medicine and Pediatric Care - Snow Mesa",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.