Pueblo West Primary Care LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PUEBLO WEST PRIMARY CARE LLC

Doing business as

Pueblo West Primary Care

Practice address

141 S Purcell Blvd Ste 140
Pueblo West, CO 81007-5123

Phone

(719) 281-9587

Fax

(719) 960-2054

NPI assigned

Jun 5, 2019

Organization subpart

No

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

Authorized official

Name

Terri Shawcroft

Title

Office Manager

Phone

(719) 251-9465

Specialties & licenses 1

Addresses

Other names 1

• Pueblo West Primary Care Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19630/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shelby Duffey, AGACNP-BC, FNP-BC

  • Nurse Practitioner
  • Pueblo West, CO
  • NPI 1902675218
  Medicare reassignment Care Compare group NPD
• Amanda C Fadenrecht, FNP-C

  • Primary Care Nurse Practitioner
  • Pueblo West, CO
  • NPI 1023425386
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572307200000",
    "number": "1659939403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 S PURCELL BLVD STE 140",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075123",
            "telephone_number": "719-281-9587",
            "fax_number": "719-960-2054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 S PURCELL BLVD STE 140",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810075123",
            "telephone_number": "719-281-9587",
            "fax_number": "719-960-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO WEST PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-10-29",
        "status": "A",
        "authorized_official_last_name": "SHAWCROFT",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "719-251-9465"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pueblo West Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pueblo West Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pueblo West Chiropractic Health Solutions Inc.
• Pueblo West Dental, Prof.LLC (Pueblo West Neighborhood Dental and Implants)
• Pueblo West Gardens
• Pueblo West Metropolitan District
• Pueblo West Neighborhood Dental (Pueblo West Dental Care)
• Pure Spa & Wellness
• Pursuit of Happiness Counseling, LLC
• Kiaha Quint
• Brita Faye Radzymski
• Laura Jeanne Ragulsky, RN

• Family Medicine Physician in Pueblo West, CO
• Providers in Pueblo West, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.