NPIMap

Organization Active NPI

Centura Ventures, LLC

Doing business as XCS PT Broadmoor

  • Physical Therapy Clinic/Center
  • Colorado Springs, CO
National Provider Identifier
1629600754
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
CENTURA VENTURES, LLC
Doing business as
XCS PT Broadmoor
Practice address
1263 Lake Plaza Dr Ste 210B
Colorado Springs, CO 80906-3564
Phone
(719) 776-3350
Fax
(719) 776-3374
NPI assigned
Feb 6, 2020
Last updated
Dec 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Authorized official

Name
Ms. Debra Carpenter, RN
Title
VP, Ambulatory Services
Phone
(303) 765-6998

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1263 Lake Plaza Dr Ste 210B
Colorado Springs, CO 80906-3564

Mailing address

PO Box 801172
Kansas City, MO 64180-1172
Phone (800) 953-0104

Other names 3

  • XCS PT BROADMOOR Doing business as
  • Centura Physical Therapy at Broadmoor Other name
  • Colorado Sport and Spine Centers Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181221002214 CO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8628989043 Receives reassigned benefits from 32 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Woodland Park, CO; Pueblo, CO; Monument, CO; Colorado Springs, CO; Frisco, CO

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1629600754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801172",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801172",
            "telephone_number": "800-953-0104",
            "fax_number": "303-765-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 LAKE PLAZA DR STE 210B",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063564",
            "telephone_number": "719-776-3350",
            "fax_number": "719-776-3374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTURA VENTURES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "VP, AMBULATORY SERVICES",
        "authorized_official_telephone_number": "303-765-6998",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "XCS PT BROADMOOR",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Centura Physical Therapy at Broadmoor",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Centura Physical Therapy at Broadmoor",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Colorado Sport and Spine Centers",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.