Individual provider Active NPI

Melissa B. Gillespie

  • Emergency Medicine Physician
  • Boulder, CO
National Provider Identifier
1649208471
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DR.0056823 Issued in CO
Practice address
4747 Arapahoe Ave
Boulder, CO 80303-1131
Phone
(303) 415-7000
Fax
(303) 306-7753
NPI assigned
Jun 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036-084265 IL
Emergency Medicine Physician 207P00000X DR.0056823 CO Primary

Addresses

Primary practice location

4747 Arapahoe Ave
Boulder, CO 80303-1131

Mailing address

PO Box 173894
Denver, CO 80217-3894
Phone (303) 306-7783

Other identifiers 2

IdentifierTypeStateIssuer
036-084265MedicaidIL
DR.0056823OtherCOCOLORADO MEDICAL LICENSE

Other names 1

  • Melissa B. Gillespie Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160707002126 CO Practitioner - Emergency Medicine 6709885742 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-084265ILMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Emergency Physicians PC Emergency Medicine CurrentSince May 28, 2016 Accepting new patients
Boulder Community Health CurrentSince Jul 1, 2016 Accepting new patients
Boulder Emergency Physicians PC Emergency Medicine CurrentSince May 28, 2016 Accepting new patients
Boulder Community Health Emergency Medicine CurrentSince Jul 1, 2016 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health Past Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

4747 Arapahoe Ave
Boulder, CO 80303
Phone (303) 415-7000

4801 Riverbend Rd
Ste 300
Boulder, CO 80301
Phone (303) 415-8621

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466553600000",
    "number": "1649208471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 173894",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802173894",
            "telephone_number": "303-306-7783",
            "fax_number": "303-306-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 ARAPAHOE AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803031131",
            "telephone_number": "303-415-7000",
            "fax_number": "303-306-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLESPIE",
        "first_name": "MELISSA",
        "middle_name": "B.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2016-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-084265",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "DR.0056823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-084265",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO MEDICAL LICENSE",
            "identifier": "DR.0056823",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "GILLESPIE",
            "middle_name": "B.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.