NPIMap

Organization Active NPI

Radiant Healthcare LLC

  • Rural Health Clinic/Center
  • Rocky Ford, CO
National Provider Identifier
1659003200
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RADIANT HEALTHCARE LLC
Practice address
1014 Elm Ave
Rocky Ford, CO 81067-1328
Phone
(719) 254-7421
NPI assigned
Jun 30, 2022
Last updated
Feb 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Authorized official

Name
Amanda Maxwell
Title
Office Manager
Phone
(719) 254-7421

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1014 Elm Ave
Rocky Ford, CO 81067-1328

Mailing address

1014 Elm Ave
Rocky Ford, CO 81067-1328
Phone (719) 254-7421

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL radianthealthcarecolorado@gmail.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230302000695 CO Part A Provider - Rural Health Clinic 6406229038 Practice locations: Rocky Ford, CO
O20230810001876 CO Part B Supplier - Clinic/Group Practice 6406229038 Receives reassigned benefits from 4 practitioners
Practice locations: Rocky Ford, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659003200. Details of each certification follow.

Rural health clinic certification: CCN 063837

Legal name
RADIANT HEALTHCARE LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 24, 1992
Last certification
Aug 26, 2025
Ownership / control type
1B
Most recent change of ownership
Jan 1, 2023 (2 total)
Organization structure
LLCProprietary
Incorporated
Jan 1, 2023 in CO
Enrollment address
1014 Elm Ave
Rocky Ford, CO 81067-1328

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
06D1013194Radiant Healthcare, LLC1014 E Elm, Rocky Ford, CO 81067Provider-performed microscopyJun 2, 2027

National Provider Directory

National Provider Directory

Locations

1014 Elm Ave
Rocky Ford, CO 81067
Phone (719) 254-7421

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Amanda Maxwell Individual W-2 Managing EmployeeAdministrator Jan 1, 2024
Ann Lopkoff Individual W-2 Managing EmployeeBusiness Manager Jan 1, 2023 100%
Heather a Elliott Individual 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2023 Change of OwnershipThis provider was the buyer Rocky Ford Family Health Center LLCCCN 063837, CO, NPI 1508932757

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 5

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": "1656547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1659003200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 ELM AVE",
            "city": "ROCKY FORD",
            "state": "CO",
            "postal_code": "810671328",
            "telephone_number": "719-254-7421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 ELM AVE",
            "city": "ROCKY FORD",
            "state": "CO",
            "postal_code": "810671328",
            "telephone_number": "719-254-7421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-30",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "719-254-7421"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "radianthealthcarecolorado@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Clinic",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1014 Elm Ave",
            "city": "Rocky Ford",
            "state": "CO",
            "country_code": "US",
            "postal_code": "810671328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rocky Ford, CO

Sources for this page

Verify at the official NPI Registry.