NPIMap

Organization Active NPI

Madison Street Provider Network Inc

  • Ophthalmology Physician
  • Denver, CO
National Provider Identifier
1699768663
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
MADISON STREET PROVIDER NETWORK INC
Practice address
55 Madison St Ste 355
Denver, CO 80206-5429
Phone
(303) 377-2020
Fax
(303) 377-2022
NPI assigned
Aug 25, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
George L Neal
Title
President & Secretary
Phone
(469) 214-0144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X CO
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

55 Madison St Ste 355
Denver, CO 80206-5429

Mailing address

55 Madison St Ste 355
Denver, CO 80206-5429
Phone (303) 377-2020

Other practice location 1

6881 S Yosemite St
Centennial, CO 80112-1406
Phone (303) 377-2020

Other practice location 2

4103 Boardwalk Dr Unit 100
Fort Collins, CO 80525-5933
Phone (303) 377-2020

Other practice location 3

1371 Hecla Dr Ste C
Louisville, CO 80027-2318
Phone (303) 377-2020

Other practice location 4

10001 Washington St
Thornton, CO 80229-2050
Phone (303) 451-8075

Other practice location 5

606 S 4th Ave
Brighton, CO 80601-3202
Phone (303) 377-2020

Other practice location 6

125 Inverness Dr E Ste 200
Englewood, CO 80112-5138
Phone (303) 733-2020

Other identifiers 2

IdentifierTypeStateIssuer
04012274MedicaidCO
12832278MedicaidCO

Other names 1

  • Omni Eye Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109000347 CO Part B Supplier - Clinic/Group Practice 5193742948 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Westminster, CO; Golden, CO; Fort Collins, CO; Englewood, CO; Denver, CO; Aurora, CO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

203 Telluride St
Unit 900
Brighton, CO 80601

55 Madison St
Ste 55
Denver, CO 80206

125 Inverness Dr E
Ste 200
Englewood, CO 80112
Phone (303) 708-8234

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1699768663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MADISON ST STE 355",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802065429",
            "telephone_number": "303-377-2020",
            "fax_number": "303-377-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MADISON ST STE 355",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802065429",
            "telephone_number": "303-377-2020",
            "fax_number": "303-377-2022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6881 S Yosemite St",
            "address_purpose": "LOCATION",
            "city": "Centennial",
            "state": "CO",
            "postal_code": "801121406",
            "country_code": "US",
            "telephone_number": "303-377-2020",
            "fax_number": "303-329-7165",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4103 Boardwalk Dr Unit 100",
            "address_purpose": "LOCATION",
            "city": "Fort Collins",
            "state": "CO",
            "postal_code": "805255933",
            "country_code": "US",
            "telephone_number": "303-377-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1371 Hecla Dr Ste C",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "CO",
            "postal_code": "800272318",
            "country_code": "US",
            "telephone_number": "303-377-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10001 Washington St",
            "address_purpose": "LOCATION",
            "city": "Thornton",
            "state": "CO",
            "postal_code": "802292050",
            "country_code": "US",
            "telephone_number": "303-451-8075",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "606 S 4th Ave",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "CO",
            "postal_code": "806013202",
            "country_code": "US",
            "telephone_number": "303-377-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 Inverness Dr E Ste 200",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "CO",
            "postal_code": "801125138",
            "country_code": "US",
            "telephone_number": "303-733-2020",
            "fax_number": "303-377-2022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MADISON STREET PROVIDER NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "NEAL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT & SECRETARY",
        "authorized_official_telephone_number": "469-214-0144"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04012274",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12832278",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omni Eye Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Omni Eye Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.