NPIMap

Organization Active NPI

Optumcare Colorado Medical Group LLC

  • Non-Pharmacy Dispensing Site
  • Colorado Springs, CO
National Provider Identifier
1659641900
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
OPTUMCARE COLORADO MEDICAL GROUP LLC
Practice address
1633 Medical Center PT
Colorado Springs, CO 80907-5700
Phone
(719) 636-2999
Fax
(719) 475-2042
NPI assigned
Jan 4, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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

Authorized official

Name
Emily Castillo
Title
Associate Director Credentialing
Phone
(702) 579-3253

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

1633 Medical Center PT
Colorado Springs, CO 80907-5700

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380
Phone (702) 579-3203

Other names 4

  • Optum Colorado Springs Doing business as
  • Colorado Springs Health Partners LLC Former legal business name
  • DaVita Medical Group Colorado Springs LLC Former legal business name
  • OptumCare Colorado Springs LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Davita Med GRP Co Springs61 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1633 Medical Center Pt
Ste 122
Colorado Springs, CO 80907

NPI Registry JSON

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1659641900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380",
            "telephone_number": "702-579-3203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 MEDICAL CENTER PT",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809075700",
            "telephone_number": "719-636-2999",
            "fax_number": "719-475-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE COLORADO MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-04",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "CASTILLO",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR CREDENTIALING",
        "authorized_official_telephone_number": "702-579-3253"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum Colorado Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optum Colorado Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colorado Springs Health Partners LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "DaVita Medical Group Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "OptumCare Colorado Springs LLC",
            "code": "4",
            "type": "Former Legal Business 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 Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.