NPIMap

Individual provider Active NPI

Mark Elden Bodman, DO

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1619986833
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37981 Issued in CO
Practice address
9480 Briar Village PT
Suite 200
Colorado Springs, CO 80920-7922
Phone
(719) 278-3627
Fax
(719) 623-2101
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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 37981 CO Primary

Addresses

Primary practice location

9480 Briar Village PT
Suite 200
Colorado Springs, CO 80920-7922

Mailing address

9480 Briar Village PT
Suite 200
Colorado Springs, CO 80920-7922
Phone (719) 278-3627

Other identifiers 1

IdentifierTypeStateIssuer
98172549MedicaidCO

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
I20041123000132 CO Practitioner - Osteopathic Manipulative MedicinePractitioner - Family Practice 6608831268 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Osteopathic Manipulative MedicineAlso: Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

9480 Briar Village PT
Colorado Springs, CO 80920-7922
Phone (719) 623-2101

Hospital & facility affiliations

  • Uch-Memorial Health System Hospital, Colorado Springs, CO, CCN 060022
  • Uchealth Grandview Hospital Hospital, Colorado Springs, CO, CCN 060130

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions12

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37981COMDFamily Medicine Physician

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398297600000",
    "number": "1619986833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9480 BRIAR VILLAGE PT",
            "address_2": "SUITE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207922",
            "telephone_number": "719-278-3627",
            "fax_number": "719-623-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9480 BRIAR VILLAGE PT",
            "address_2": "SUITE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207922",
            "telephone_number": "719-278-3627",
            "fax_number": "719-623-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODMAN",
        "first_name": "MARK",
        "middle_name": "ELDEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2014-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "37981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "98172549",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.