NPIMap

Organization Active NPI

Colorado Coalition for the Homeless

Doing business as Stout Street Clinic - Pharmacy

  • Clinic Pharmacy
  • Denver, CO
National Provider Identifier
1689857153
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
COLORADO COALITION FOR THE HOMELESS
Doing business as
Stout Street Clinic - Pharmacy
Stout Street Health Center
Practice address
2130 Stout Street
Denver, CO 80205-2827
Phone
(303) 293-3979
Fax
(303) 293-6514
NPI assigned
Dec 7, 2007
Last updated
Oct 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Pete J Stoller
Title
Cfo
Phone
(303) 312-9606

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Clinic Pharmacy 3336C0002X NU Primary

Addresses

Primary practice location

2130 Stout Street
Denver, CO 80205-2827

Mailing address

2130 Stout Street
Denver, CO 80205-2827
Phone (303) 293-3979

Other identifiers 1

IdentifierTypeStateIssuer
79000053MedicaidCO

Other names 2

  • Stout Street Clinic - Pharmacy Doing business as
  • Stout Street Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220720003088 CO Part B Supplier - Pharmacy 7618958687 Practice locations: Denver, CO

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
06D0701735Stout Street Health Center2130 Stout St, Denver, CO 80205Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Colorado Coalition for the38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West End Health CenterDenver, CO, CCN 061922 Federally qualified health center 5% Or Greater Direct Ownership Interest Apr 10, 2012
Ft Lyon Health Care for the HomelessFort Lyon, CO, CCN 061952 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 2, 2014
2100 Broadway Services BuildingDenver, CO, CCN 061955 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 20, 2014
Colorado Coalition for the HomelessDenver, CO, CCN 061035 Federally qualified health center 5% Or Greater Direct Ownership Interest (0.05%) Mar 7, 2022
Stout Street Recuperative Care CenterDenver, CO, CCN 061045 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2022

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1689857153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2130 STOUT STREET",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052827",
            "telephone_number": "303-293-3979",
            "fax_number": "303-293-6514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 STOUT STREET",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052827",
            "telephone_number": "303-293-3979",
            "fax_number": "303-293-6514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO COALITION FOR THE HOMELESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-07",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "STOLLER",
        "authorized_official_first_name": "PETE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "303-312-9606"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "79000053",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stout Street Clinic - Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stout Street Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.