NPIMap

Individual provider Active NPI

Sofia Mani Davies, DO, MS

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1679078059
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0062933 Issued in CO
Practice address
1645 Broadway
Boulder, CO 80302-6218
Phone
(303) 415-8900
Fax
(303) 443-6476
NPI assigned
Mar 27, 2018
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X DR.0062933 CO Primary

Addresses

Primary practice location

1645 Broadway
Boulder, CO 80302-6218

Mailing address

PO Box 9049
Boulder, CO 80301-9049
Phone (303) 415-8900

Other practice location 1

2995 Baseline Rd
Boulder, CO 80303-2318
Phone (303) 415-8900

Other names 1

  • Dr. Sofia Mani Former name

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
I20191107000736 CO Practitioner - Family Practice 5890042345 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2018
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)

2995 Baseline Rd
Suite 210
Boulder, CO 80303-2318
Phone (303) 415-8900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Science

State licenses

LicenseStateTypeSpecialty
DR.0062933COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Aug 23, 2021 Accepting new patients
Boulder Community Health CurrentSince Aug 23, 2021 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health Past Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

1645 Broadway
Boulder, CO 80302
Phone (303) 415-8900

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

2995 Baseline Rd
Ste 210
Boulder, CO 80303
Phone (303) 415-8900

5450 Western Ave
Boulder, CO 80301
Phone (303) 415-4770

Organizations & group practices 5

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": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1679078059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9049",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803019049",
            "telephone_number": "303-415-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 BROADWAY",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803026218",
            "telephone_number": "303-415-8900",
            "fax_number": "303-443-6476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2995 Baseline Rd",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803032318",
            "country_code": "US",
            "telephone_number": "303-415-8900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIES",
        "first_name": "SOFIA",
        "middle_name": "MANI",
        "name_prefix": "Dr.",
        "credential": "DO, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-27",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0062933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SOFIA",
            "last_name": "MANI",
            "prefix": "DR.",
            "credential": "DO, MS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.