NPIMap

Organization Active NPI

Ponderosa Family Physicians PC

  • Family Medicine Physician
  • Aurora, CO
National Provider Identifier
1629021209
Registry record updated Oct 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PONDEROSA FAMILY PHYSICIANS PC
Practice address
14991 E Hampden Ave
Suite 210
Aurora, CO 80014
Phone
(303) 690-4891
Fax
(303) 690-5082
NPI assigned
May 18, 2006
Last updated
Oct 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2013

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

Authorized official

Name
Steve P Elliott
Title
Office Manager
Phone
(303) 537-1010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

14991 E Hampden Ave
Suite 210
Aurora, CO 80014

Mailing address

14991 E Hampden Ave
Suite 210
Aurora, CO 80014
Phone (303) 690-4891

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000792 CO Part B Supplier - Clinic/Group Practice 1658261854 Receives reassigned benefits from 11 practitioners
Practice locations: Aurora, 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
06D0510783Ponderosa Family Physicians14991 East Hampden Avenue Suite 210, Aurora, CO 80014Provider-performed microscopyMar 3, 2028

National Provider Directory

National Provider Directory

Locations

14991 E Hampden Ave
Ste 210
Aurora, CO 80014
Phone (303) 690-4891

Practitioners & affiliated clinicians

Practitioners 11

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": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380844800000",
    "number": "1629021209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14991 E HAMPDEN AVE",
            "address_2": "SUITE 210",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "80014",
            "telephone_number": "303-690-4891",
            "fax_number": "303-690-5082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14991 E HAMPDEN AVE",
            "address_2": "SUITE 210",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "80014",
            "telephone_number": "303-690-4891",
            "fax_number": "303-690-5082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONDEROSA FAMILY PHYSICIANS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2013-10-04",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "303-537-1010"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; 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.