NPIMap

Individual provider Active NPI

Peter Charles Stubenrauch, MD

  • Pulmonary Disease Physician
  • Denver, CO
National Provider Identifier
1669528345
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
45543 Issued in CO
Practice address
1400 Jackson St
Denver, CO 80206-2761
Phone
(303) 388-4461
Fax
(303) 270-2206
NPI assigned
Jan 26, 2007
Last updated
Mar 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 45543 CO Primary

Addresses

Primary practice location

1400 Jackson St
Denver, CO 80206-2761

Mailing address

1400 Jackson St
Denver, CO 80206-2761
Phone (303) 388-4461

Other identifiers 1

IdentifierTypeStateIssuer
78030331MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address NJHealth@njc.allscriptsdirect.net

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
I20070613000469 CO Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 0042318115 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Rush Medical College of Rush University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

4820 Riverbend Rd
Suite 100
Boulder, CO 80301-2618
Phone (303) 415-5399

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45543COMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Dec 1, 2022 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health CurrentSince Dec 1, 2022 Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

4820 Riverbend Rd
Ste 100
Boulder, CO 80301
Phone (303) 415-5399

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

4743 Arapahoe Ave
Boulder, CO 80303
Phone (303) 444-9000

4743 Arapahoe Ave
Ste 201C
Boulder, CO 80303
Phone (303) 442-2150

101 Erie Pkwy
Erie, CO 80516
Phone (303) 415-5810

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1669528345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 JACKSON ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802062761",
            "telephone_number": "303-388-4461",
            "fax_number": "303-398-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 JACKSON ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802062761",
            "telephone_number": "303-388-4461",
            "fax_number": "303-270-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUBENRAUCH",
        "first_name": "PETER",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CO",
            "license": "45543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78030331",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NJHealth@njc.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "1400 Jackson St",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802062761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.