NPIMap

Organization Active NPI

Pediatrics 5280 PC

  • Primary Care Clinic/Center
  • Centennial, CO
National Provider Identifier
1629030689
Registry record updated Jul 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PEDIATRICS 5280 PC
Practice address
9094 E Mineral Ave
Suite 120
Centennial, CO 80112-7200
Phone
(303) 779-5437
Fax
(303) 689-9628
NPI assigned
Apr 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2008

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

Authorized official

Name
Robert Holbrook Stapp, MDNPI 1952363905
Title
President Physician
Phone
(303) 779-5437

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

9094 E Mineral Ave
Suite 120
Centennial, CO 80112-7200

Mailing address

9094 E Mineral Ave
Suite 120
Centennial, CO 80112-7200
Phone (303) 779-5437

Other identifiers 1

IdentifierTypeStateIssuer
4013280MedicaidCO

Other names 1

  • Pediatrics DTC PC Former legal business name

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
06D0511679Pediatrics 5280, PC9094 E Mineral Ave, Suite 120, Centennial, CO 80112Certificate of waiverFeb 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pediatrics 52802 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2352 Meadows Blvd
Ste 150
Castle Rock, CO 80109
Phone (303) 779-5437

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": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1629030689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9094 E MINERAL AVE",
            "address_2": "SUITE 120",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801127200",
            "telephone_number": "303-779-5437",
            "fax_number": "303-689-9628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9094 E MINERAL AVE",
            "address_2": "SUITE 120",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801127200",
            "telephone_number": "303-779-5437",
            "fax_number": "303-689-9628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS 5280 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "STAPP",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "HOLBROOK",
        "authorized_official_title_or_position": "PRESIDENT PHYSICIAN",
        "authorized_official_telephone_number": "303-779-5437",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4013280",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatrics DTC PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Centennial, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.