NPIMap

Individual provider Active NPI

Kenneth Michael Patrick, MD

  • Emergency Medicine Physician
  • Ft Collins, CO
National Provider Identifier
1639119845
Registry record updated Feb 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
44174 Issued in CO
Practice address
1024 Lemay Ave
Ft Collins, CO 80524-3913
Phone
(800) 553-4924
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 44174 CO Primary

Addresses

Primary practice location

1024 Lemay Ave
Ft Collins, CO 80524-3913

Mailing address

Dept 2215
Denver, CO 80291-0001
Phone (800) 553-4924

Other identifiers 4

IdentifierTypeStateIssuer
P00394962OtherCORAILROAD MEDICARE
123463300MedicaidWY
64435865MedicaidCO
S5008OtherCOBCBS

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
I20060920000060 CO Practitioner - Emergency Medicine 3476579178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Midwestern University, Chicago College of Osteopathic Med, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1024 S Lemay Ave
Poudre Valley Hospital
Fort Collins, CO 80524-3929
Phone (970) 495-7000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.04 of 100Reported as group
Quality
87.35
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44174COMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of the Rockies, PC Emergency Medicine CurrentSince Jul 1, 2006 Accepting new patients
Emergency Physicians of the Rockies, PC Emergency Medicine CurrentSince Jul 1, 2006 Accepting new patients

Locations

1024 S Lemay Ave
Fort Collins, CO 80524
Phone (970) 495-7000

Organizations & group practices 2

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298505600000",
    "number": "1639119845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 2215",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802910001",
            "telephone_number": "800-553-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 LEMAY AVE",
            "city": "FT COLLINS",
            "state": "CO",
            "postal_code": "805243913",
            "telephone_number": "800-553-4924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "KENNETH",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "44174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00394962",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123463300",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64435865",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "S5008",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ft Collins, CO

Sources for this page

Verify at the official NPI Registry.